Provider Demographics
NPI:1992329015
Name:WHITEHEAD, BILLIE (BHWC)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:BHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18903 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-6503
Mailing Address - Country:US
Mailing Address - Phone:918-724-3710
Mailing Address - Fax:
Practice Address - Street 1:1101 S BELMONT AVE STE 106
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6315
Practice Address - Country:US
Practice Address - Phone:918-758-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program