Provider Demographics
NPI:1144321456
Name:WRIGHT, DEANNA ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ELIZABETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:ELIZABETH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1008
Mailing Address - Country:US
Mailing Address - Phone:918-458-1515
Mailing Address - Fax:918-207-0226
Practice Address - Street 1:1502 E. SHAWNEE CIRCLE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-458-1515
Practice Address - Fax:918-207-0226
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0049721363LW0102X
OK49721207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054520AMedicaid
OK200054520AMedicaid
OKOK403919Medicare PIN
OKS89588Medicare UPIN