Healthcare Provider Details

I. General information

NPI: 1154088839
Provider Name (Legal Business Name): RED RIVER VALLEY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11530 RIDGE RD STE 1
THACKERVILLE OK
73459-9623
US

IV. Provider business mailing address

11530 RIDGE RD STE 1
THACKERVILLE OK
73459-9623
US

V. Phone/Fax

Practice location:
  • Phone: 580-276-9066
  • Fax: 580-276-9063
Mailing address:
  • Phone: 580-276-9066
  • Fax: 580-276-9063

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: RACHEL S PRESLEY
Title or Position: OWNER
Credential: APRN
Phone: 405-568-5055