Provider Demographics
NPI:1295327716
Name:DICKENS, SHAKINDA
Entity type:Individual
Prefix:
First Name:SHAKINDA
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 TINKER DIAGONAL ST APT 133
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-8256
Mailing Address - Country:US
Mailing Address - Phone:405-609-7556
Mailing Address - Fax:
Practice Address - Street 1:433 TINKER DIAGONAL ST APT 133
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-8256
Practice Address - Country:US
Practice Address - Phone:405-609-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V810340717374U00000X
OK37V1080340717376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide