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MRS. CODI NICOLE CASTLEBERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
11426 N 134TH EAST AVE, OWASSO, OK 74055-4715
(918) 376-6345
(918) 376-6635
Mailing address
11426 N 134TH EAST AVE, OWASSO, OK 74055-4715
(918) 376-6345

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2891
OK

Other

Enumeration date
02/13/2018
Last updated
06/16/2020
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