Teresa Dianne Gant, CASE MANAGER

Individual provider Active NPI Case Manager/Care Coordinator · Frederick, OK

NPI 1649500372 · NPPES record last updated Dec 31, 2009

Key facts

NPI
1649500372
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
License
20174 (OK)
Practice address
22007 County Road Ew 185
Frederick, OK 73542-9118
Phone
(580) 335-5411
NPI assigned
Dec 31, 2009
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
20174OKMDCase Manager/Care Coordinator

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X 20174 OK Yes

Addresses

Primary practice location

22007 County Road Ew 185
Frederick, OK 73542-9118

Mailing address

22007 County Road Ew 185
Frederick, OK 73542-9118
Phone (580) 335-5411

Other providers in Frederick, OK

All providers in Frederick, OK · Case Manager/Care Coordinator in Oklahoma

Sources for this page

Verify at the official NPI Registry.