Healthcare Provider Details

I. General information

NPI: 1114463981
Provider Name (Legal Business Name): LADONNA CULP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 LAFITTE ST
TISHOMINGO OK
73460-2433
US

IV. Provider business mailing address

311 LAFITTE ST
TISHOMINGO OK
73460-2433
US

V. Phone/Fax

Practice location:
  • Phone: 580-387-9006
  • Fax:
Mailing address:
  • Phone: 580-387-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number96158
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number96158
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: