Individual
KATIE ALLYSE DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
2100 W IOWA AVE STE A, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2310
Mailing address
2100 W IOWA AVE STE A, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
109112
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OK
Enumeration date
09/19/2019
Last updated
09/19/2019
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