Doctor Name: | JERI L HARGRAVE |
NPI Number: | 1346240199 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | R0037216 |
Business Practice Address: | 610 E 24th Street Tishomingo, OK - 734603265 |
Business Phone Number: | 5803712343 |
Business Fax Number: | 5803712451 |
Mailing Address: | 610 E 24th Street, TISHOMINGO |
State: | OK |
Postal Code: | 734603265 |
Phone Number: | 5803712343 |
Fax Number: | 5803712451 |
NPI Enumeration Date: | 07/22/2005 |
NPI Last Update Date: | 11/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | R0037216 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |