Healthcare Provider Details

I. General information

NPI: 1558784470
Provider Name (Legal Business Name): RONDALL DUNKLE JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 15TH ST
PAWHUSKA OK
74056
US

IV. Provider business mailing address

1101 E 15TH ST
PAWHUSKA OK
74056-1901
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-3232
  • Fax:
Mailing address:
  • Phone: 918-287-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76258-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: