Provider Demographics
NPI:1255134425
Name:ROWELL, VICKIE R
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:R
Last Name:ROWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W CHICKASAW AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4414
Mailing Address - Country:US
Mailing Address - Phone:918-571-9389
Mailing Address - Fax:
Practice Address - Street 1:413 W CHICKASAW AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4414
Practice Address - Country:US
Practice Address - Phone:918-571-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist