Healthcare Provider Details

I. General information

NPI: 1699860601
Provider Name (Legal Business Name): RUTH LYNN LAMPE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH LYNN WALTERS ARNP

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E HARTFORD AVE SUITE C
PONCA CITY OK
74601-2011
US

IV. Provider business mailing address

900 E HARTFORD AVE SUITE C
PONCA CITY OK
74601-2011
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-1911
  • Fax: 580-762-0887
Mailing address:
  • Phone: 580-762-1911
  • Fax: 580-762-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberD6093646
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: