Individual
AUDREY HATHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 N.W. 39TH ST, 103, OKLAHOMA CITY, OK 73112
(405) 601-9668
(405) 606-7893
Mailing address
2401 N.W. 39TH ST, 103, OKLAHOMA CITY, OK 73112
(405) 601-9668
(405) 606-7893
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200527740A
—
OK
Enumeration date
11/18/2013
Last updated
06/10/2014
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