Organization
CREOKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ANN BAINE LPN (INPATIENT LPN)
(918) 207-9563
Entity
Organization
Contact information
Practice address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-9563
Mailing address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-9563
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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