Provider Demographics
NPI:1811602048
Name:HENDERSON, PRISCILLA VEORAH
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:VEORAH
Last Name:HENDERSON
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 1:6402 S FORREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-4687
Mailing Address - Country:US
Mailing Address - Phone:580-364-3050
Mailing Address - Fax:
Practice Address - Street 1:263 E COURT ST STE 5263E
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2016
Practice Address - Country:US
Practice Address - Phone:580-239-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator