Healthcare Provider Details

I. General information

NPI: 1073376547
Provider Name (Legal Business Name): JOHN PAUL HARGROVE BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN PAUL HARGROVE BA

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MUSTANG RD APT 3504
YUKON OK
73099-0343
US

IV. Provider business mailing address

2000 S MUSTANG RD APT 3504
YUKON OK
73099-0343
US

V. Phone/Fax

Practice location:
  • Phone: 405-274-5691
  • Fax:
Mailing address:
  • Phone: 405-274-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: