Individual
KATHERINE DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 W 4TH ST, STE. D, TAHLEQUAH, OK 74464-5013
(918) 485-0113
(918) 458-0075
Mailing address
PO BOX 662, PURCELL, OK 73080-0662
(405) 527-1785
(405) 527-1084
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
37V064210311
OK
Other
Enumeration date
11/12/2013
Last updated
11/12/2013
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