Provider Demographics
NPI:1669432001
Name:HANES, ALECIA A (MD)
Entity type:Individual
Prefix:DR
First Name:ALECIA
Middle Name:A
Last Name:HANES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1818
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:844-689-9671
Practice Address - Street 1:508 W VANDAMENT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4655
Practice Address - Country:US
Practice Address - Phone:405-350-0200
Practice Address - Fax:405-350-0024
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100119070AMedicaid