Healthcare Provider Details

I. General information

NPI: 1639012586
Provider Name (Legal Business Name): FAMCORE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E HINCHLEY ST
MCLOUD OK
74851-8140
US

IV. Provider business mailing address

34505 INDEPENDENCE ST
SHAWNEE OK
74804-8908
US

V. Phone/Fax

Practice location:
  • Phone: 405-630-5093
  • Fax:
Mailing address:
  • Phone: 405-630-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RORY BREWSTER
Title or Position: OWNER/OPERATOR
Credential: APRN
Phone: 405-630-5093