Healthcare Provider Details

I. General information

NPI: 1396045753
Provider Name (Legal Business Name): JOSEPH JAMES GELINAS APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S BROADWAY ST
GROVE OK
74344-3429
US

IV. Provider business mailing address

62500 E 247 LOOP
GROVE OK
74344-7435
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-0800
  • Fax: 918-786-0876
Mailing address:
  • Phone: 918-786-0800
  • Fax: 918-786-0876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number80573
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: