Healthcare Provider Details

I. General information

NPI: 1871133835
Provider Name (Legal Business Name): JEANNIE MARIE WYRICK DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 PITMAN ST
FORT SILL OK
73503-4473
US

IV. Provider business mailing address

4303 PITMAN ST
FORT SILL OK
73503-4473
US

V. Phone/Fax

Practice location:
  • Phone: 580-678-3856
  • Fax:
Mailing address:
  • Phone: 580-585-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number89845
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: