Individual
MS. SOPHIA DELISE HACKNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8282 S MEMORIAL DR STE 106, TULSA, OK 74133-4311
(918) 579-4200
Mailing address
12112 S 83RD EAST AVE APT 422, BIXBY, OK 74008-3344
(405) 308-5490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3052
OK
Other
Enumeration date
04/23/2019
Last updated
06/17/2019
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