Provider Demographics
NPI:1023226750
Name:OKLAHOMA DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:OKLAHOMA DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ADCOCK
Authorized Official - Last Name:CHOATE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:405-258-2640
Mailing Address - Street 1:101 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-8786
Mailing Address - Country:US
Mailing Address - Phone:405-258-2640
Mailing Address - Fax:405-258-2696
Practice Address - Street 1:823 GREYSTONE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1204
Practice Address - Country:US
Practice Address - Phone:405-742-0236
Practice Address - Fax:405-742-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0018207251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicaid