Provider Demographics
NPI:1386978740
Name:DOSSEY, KATHERINE RENE (DPH)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RENE
Last Name:DOSSEY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BEGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74421-0036
Mailing Address - Country:US
Mailing Address - Phone:918-267-4890
Mailing Address - Fax:918-267-4061
Practice Address - Street 1:8054 HWY 16 #100
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421
Practice Address - Country:US
Practice Address - Phone:918-267-4890
Practice Address - Fax:918-267-4061
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4085630001Medicare NSC