Provider Demographics
NPI:1194541235
Name:CLOVIS, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:CLOVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W 36TH ST N STE 1
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-1703
Mailing Address - Country:US
Mailing Address - Phone:918-425-4200
Mailing Address - Fax:
Practice Address - Street 1:1 W 36TH ST N STE 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1703
Practice Address - Country:US
Practice Address - Phone:918-425-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator