Healthcare Provider Details

I. General information

NPI: 1588284236
Provider Name (Legal Business Name): MVP MEDICAL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W MAIN
RATTAN OK
74562
US

IV. Provider business mailing address

PO BOX 327
RATTAN OK
74562-0327
US

V. Phone/Fax

Practice location:
  • Phone: 580-271-2004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BRANTON
Title or Position: OWNER/PROVIDER
Credential: APRN, CNP
Phone: 580-271-2004