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General NPI Number Information
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NPI Number | 1942018197
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Entity Type | Individual
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Provider Name | TEARESA PEXTON
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 262570 E 860 RD
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City | WATONGA
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State | OK
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Zip | 73772-5193
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Country | US
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Telephone | 405-234-7804
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Fax |
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Provider Business Mailing Address
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Address Line | 262570 E 860 RD
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City | WATONGA
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State | OK
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Zip | 73772-5193
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Country | US
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Telephone | 405-234-7804
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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