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General NPI Number Information
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NPI Number | 1598349292
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Entity Type | Individual
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Provider Name | MR. CORRI VESHON RHODES JR.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2021
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 300 N STATE ST STE 4
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City | WEATHERFORD
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State | OK
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Zip | 73096-5105
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Country | US
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Telephone | 405-939-5800
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Fax | 405-900-5803
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Provider Business Mailing Address
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Address Line | 6448 S WESTERN AVE STE 107
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-1711
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Country | US
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Telephone | 405-939-5800
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Fax | 405-900-5803
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 15983499292
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License Number State | OK
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