Healthcare Provider Details

I. General information

NPI: 1821043647
Provider Name (Legal Business Name): TOTAL HEALTHCARE PLUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARLINGTON ST SUITE B
ADA OK
74820-4072
US

IV. Provider business mailing address

1201 ARLINGTON ST SUITE B
ADA OK
74820-4072
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-1526
  • Fax: 580-436-1354
Mailing address:
  • Phone: 580-436-1526
  • Fax: 580-436-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMETHRIA LAURIE JACKSON
Title or Position: PRESIDENT
Credential: MSN, ARNP
Phone: 580-436-1526