Individual
CODY RAY HENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 273-1841
Mailing address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
T082671544
OK
Other
Enumeration date
01/24/2024
Last updated
01/24/2024
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