Individual
DESTANY HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1680 S GREATHOUSE DRIVE, ATOKA, OK 74525
(580) 579-0743
Mailing address
1680 S GREATHOUSE DRIVE, ATOKA, OK 74525
(580) 579-0743
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100683770A
—
OK
Enumeration date
08/27/2020
Last updated
08/27/2020
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