Provider Demographics
NPI:1447505128
Name:WOMBLE, JOYETTE MESSIAH
Entity type:Individual
Prefix:MRS
First Name:JOYETTE
Middle Name:MESSIAH
Last Name:WOMBLE
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 1:1113 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5411
Mailing Address - Country:US
Mailing Address - Phone:405-213-3521
Mailing Address - Fax:
Practice Address - Street 1:1113 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5411
Practice Address - Country:US
Practice Address - Phone:405-213-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1447559711251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health