Healthcare Provider Details

I. General information

NPI: 1306808027
Provider Name (Legal Business Name): MARTHA A FIELDS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E VAN BUREN AVE
MCALESTER OK
74501-4245
US

IV. Provider business mailing address

PO BOX 908 WARREN CLINIC MCALESTER
MCALESTER OK
74502-0908
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-0240
  • Fax: 918-423-4051
Mailing address:
  • Phone: 918-426-0240
  • Fax: 918-423-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0031138
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: