Healthcare Provider Details

I. General information

NPI: 1366988768
Provider Name (Legal Business Name): CHRISTOPHER ALAN HITCHCOCK APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST
WETUMKA OK
74883-4015
US

IV. Provider business mailing address

109 S MAIN ST
WETUMKA OK
74883-4015
US

V. Phone/Fax

Practice location:
  • Phone: 405-452-5400
  • Fax:
Mailing address:
  • Phone: 405-452-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF0117230
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: