=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902712631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANITA GAY HARJO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2026
-----------------------------------------------------
Last Update Date | 08/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MCDOUGAL DR
-----------------------------------------------------
City | HOLDENVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74848-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-379-3313
-----------------------------------------------------
Fax | 405-379-7223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1909 PHELPS DR
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74868-2660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-379-3313
-----------------------------------------------------
Fax | 405-379-7223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------