Basic Information
| Provider Information | |||||||||
| NPI: | 1053443176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANKINS | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1116 N 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747014426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809246363 | ||||||||
| FaxNumber: | 5809240379 | ||||||||
| Practice Location | |||||||||
| Address1: | 1312 N 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747012810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809202069 | ||||||||
| FaxNumber: | 5809201010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 48 | OK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.