Provider Demographics
NPI:1194509497
Name:HAHN, MISTY D
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:HAHN
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 1:1101 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1718
Mailing Address - Country:US
Mailing Address - Phone:405-826-6818
Mailing Address - Fax:
Practice Address - Street 1:1101 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1718
Practice Address - Country:US
Practice Address - Phone:405-826-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist