| Doctor Name: | KISHA MARIE FARRELL |
| NPI Number: | 1104199470 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN FNP-BC |
| License Number: | 72827 |
| Business Practice Address: | 119 W Main St Hominy, OK - 740351031 |
| Business Phone Number: | 9188854640 |
| Business Fax Number: | 9188854644 |
| Mailing Address: | 212 N Main St, FAIRFAX |
| State: | OK |
| Postal Code: | 746373023 |
| Phone Number: | 9186423100 |
| Fax Number: | 9186425639 |
| NPI Enumeration Date: | 02/17/2012 |
| NPI Last Update Date: | 06/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 72827 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |