Provider Demographics
NPI:1548078769
Name:REY, RANDA RENEE (CASE MANAGEMENT/)
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:RENEE
Last Name:REY
Suffix:
Gender:F
Credentials:CASE MANAGEMENT/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E 88TH ST # 619
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2432
Mailing Address - Country:US
Mailing Address - Phone:539-238-8422
Mailing Address - Fax:
Practice Address - Street 1:2525 E 88TH ST # 619
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2432
Practice Address - Country:US
Practice Address - Phone:539-238-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator