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NPI Code Detail

MEDICARE: DANETTA WATKINS

MEDICARE: DANETTA WATKINS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1952701542
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANETTA WATKINS
Provider Business Mailing Address
First Line : 7010 S YALE AVE STE 215
Second Line :
City : TULSA
State : OK
Zip : 74136-5743
Country : US
Telephone Number : 918-245-5565
Fax Number : 918-245-5564
Provider Business Practice Location Address
First Line : 401 E BROADWAY CT STE E
Second Line :
City : SAND SPRINGS
State : OK
Zip : 74063-7931
Country : US
Telephone Number : 918-245-5565
Fax Number : 918-245-5564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2014
Last Update Date : 09/02/2014

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Directions to “ DANETTA WATKINS ” Practice Location

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