Healthcare Provider Details

I. General information

NPI: 1871544338
Provider Name (Legal Business Name): PATRICIA OWENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WANDA ST
MARIETTA OK
73448-1229
US

IV. Provider business mailing address

301 WANDA ST
MARIETTA OK
73448-1229
US

V. Phone/Fax

Practice location:
  • Phone: 580-276-2400
  • Fax: 580-276-4358
Mailing address:
  • Phone: 580-276-2400
  • Fax: 580-276-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0037898
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: