| Organization Name: | WELLSTON FAMILY MEDICAL CLINIC, PLLC |
| NPI Number: | 1023348059 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHERRY DIANN MITCHELL (ARNP) |
| Mailing Address: | 309 W. 2nd St. Wellston |
| State: | OK US |
| Postal Code: | 74881 |
| Phone Number: | 4053562998 |
| Fax Number: | 4052580498 |
| NPI Enumeration Date: | 01/14/2010 |
| NPI Last Update Date: | 01/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R0080778 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |