MEDICARE: CHASSI GRACEANN DOWDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1043147168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASSI GRACEANN DOWDY

Provider Business Mailing Address
First Line	:	1796 N 204TH ST W
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-5010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1796 N 204TH ST W
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-5010
Country	:	US
Telephone Number	:	918-758-8625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ CHASSI GRACEANN DOWDY ” Practice Location

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