Individual
ELLEN CIERRA KLEINERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 W MAIN ST, TISHOMINGO, OK 73460-1723
(903) 267-4283
Mailing address
108 W MAIN ST, TISHOMINGO, OK 73460-1723
(903) 267-4283
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1995
—
OK
05
—
730618672
—
OK
Enumeration date
12/16/2019
Last updated
12/16/2019
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