Provider Demographics
NPI:1194065540
Name:DENSON, AUDREA BURNETTE
Entity type:Individual
Prefix:MS
First Name:AUDREA
Middle Name:BURNETTE
Last Name:DENSON
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 1:10525 APPLEGROVE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-7061
Mailing Address - Country:US
Mailing Address - Phone:405-613-3859
Mailing Address - Fax:
Practice Address - Street 1:10525 APPLEGROVE CIR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-7061
Practice Address - Country:US
Practice Address - Phone:405-613-3859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker