Healthcare Provider Details

I. General information

NPI: 1801308010
Provider Name (Legal Business Name): GARRETT NEWTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 14TH AVE NW
ARDMORE OK
73401-1828
US

IV. Provider business mailing address

1011 14TH AVE NW
ARDMORE OK
73401-1828
US

V. Phone/Fax

Practice location:
  • Phone: 580-220-6132
  • Fax: 580-220-6772
Mailing address:
  • Phone: 580-220-6132
  • Fax: 580-220-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110108
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: