Individual
KORI BETH WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
407 W SOUTH AVE, PONCA CITY, OK 74601-6133
(918) 273-1841
Mailing address
407 W SOUTH AVE, PONCA CITY, OK 74601
(918) 273-1841
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
G083831193
OK
Other
Enumeration date
09/09/2022
Last updated
09/09/2022
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