Individual
KATRINA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
57523 MOCCASIN TRAIL RD, PRAGUE, OK 74864-1143
(405) 567-0054
Mailing address
PO BOX 271, BOLEY, OK 74829-0271
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/25/2011
Last updated
07/25/2011
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