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General NPI Number Information
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NPI Number | 1275063497
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Entity Type | Individual
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Provider Name | DARYLIN DOUBLEHEAD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | RR 6 BOX 840
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City | STILWELL
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State | OK
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Zip | 74960-8703
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Country | US
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Telephone | 918-696-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 800 N OKLAHOMA AVE APT 1155
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-4406
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Country | US
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Telephone | 918-696-9583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 109794
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 109794
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License Number State | OK
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