Individual
VICKI CRAIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
RR 1 BOX 70-2, GORE, OK 74435-9524
(918) 348-4714
Mailing address
RR 1 BOX 70-2, GORE, OK 74435-9524
(918) 348-4714
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200305190B
—
OK
Enumeration date
06/07/2012
Last updated
06/07/2012
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