Organization Name: | DEER CREEK FAMILY HEALTHCARE AND WELLNESS CLINIC LLC |
NPI Number: | 1003227414 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIM KNOX (NURSE PRACTITIONER / OWNER) |
Mailing Address: | 19401 N. Portland Edmond |
State: | OK US |
Postal Code: | 73012 |
Phone Number: | 4058128208 |
Fax Number: | |
NPI Enumeration Date: | 05/20/2014 |
NPI Last Update Date: | 06/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |