MEDICARE: AMELIA DAWN RAKESTRAW

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	175T00000X	Peer Specialist		OK

General Provider Information

NPI Number	:	1679410922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA DAWN RAKESTRAW

Provider Business Mailing Address
First Line	:	1803 S WOOD DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6825
Country	:	US
Telephone Number	:	918-756-9250
Fax Number	:	918-756-9187

Provider Business Practice Location Address
First Line	:	1803 S WOOD DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6825
Country	:	US
Telephone Number	:	918-756-9250
Fax Number	:	918-756-9187

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ AMELIA DAWN RAKESTRAW ” Practice Location

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