Provider Demographics
NPI:1063281491
Name:COLE, CHLOE CALISTA
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:CALISTA
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15516 SW 1010 AVE
Mailing Address - Street 2:
Mailing Address - City:TUSKAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:74574-1304
Mailing Address - Country:US
Mailing Address - Phone:918-429-4154
Mailing Address - Fax:
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4043
Practice Address - Country:US
Practice Address - Phone:918-465-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator