Healthcare Provider Details

I. General information

NPI: 1619721370
Provider Name (Legal Business Name): OKIE PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E PAMS DR
PERKINS OK
74059-5011
US

IV. Provider business mailing address

417 E PAMS DR
PERKINS OK
74059-5011
US

V. Phone/Fax

Practice location:
  • Phone: 620-417-6363
  • Fax:
Mailing address:
  • Phone: 620-417-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BALDRIDGE
Title or Position: OWNER
Credential: APRN-CNP
Phone: 620-417-6360