Healthcare Provider Details

I. General information

NPI: 1538651104
Provider Name (Legal Business Name): SPRING GENNAY MADDOX CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19136 COUNTY ROAD 3590
ADA OK
74820-0449
US

IV. Provider business mailing address

19136 COUNTY ROAD 3590
ADA OK
74820-0449
US

V. Phone/Fax

Practice location:
  • Phone: 209-768-5793
  • Fax:
Mailing address:
  • Phone: 209-768-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR013568
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: