MEDICARE: PAIGE REANN HUGHEN-GREEN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1639754229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE REANN HUGHEN-GREEN

Provider Business Mailing Address
First Line	:	520 POINTE PARKWAY BLVD
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-0600
Country	:	US
Telephone Number	:	405-805-6403
Fax Number	:

Provider Business Practice Location Address
First Line	:	13913 S WESTERN AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173
Country	:	US
Telephone Number	:	405-445-5567
Fax Number	:

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	01/30/2025

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