Provider Demographics
NPI:1992410021
Name:KNOX, SAVANNAH RAE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RAE
Last Name:KNOX
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 1:35540 HIGHWAY 99A
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-7801
Mailing Address - Country:US
Mailing Address - Phone:580-320-5824
Mailing Address - Fax:
Practice Address - Street 1:117 ROGERS DR
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848
Practice Address - Country:US
Practice Address - Phone:405-379-6668
Practice Address - Fax:405-379-5372
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist