Individual
MR. CHARLES JESSE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24800 S 4420 RD, VINITA, OK 74301-5544
(918) 256-7841
Mailing address
PO BOX 69, VINITA, OK 74301-0069
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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