Individual
CHASTITY FAWN BAKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 W MAIN ST, TISHOMINGO, OK 73460-1723
(580) 371-3019
(580) 371-0138
Mailing address
PO BOX 970, TISHOMINGO, OK 73460-0970
(580) 371-3019
(580) 371-0138
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/31/2020
Last updated
01/31/2020
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