Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7083 | OK |
N | 1223G0001X | General Practice | 7083 | OK |
N | 213EG0000X | General Practice | 7083 | OK |
NPI | 1518443738 |
---|---|
Provider Name | Dr. Deandra Hayes |
First Address | Hulbert, OK 74441-2698 |
Second Address | Muskogee, OK 74403-6253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 07/04/2020 |