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General NPI Number Information
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NPI Number | 1013380385
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Entity Type | Organization
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Legal Business Name | MY FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 11/08/2015
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 1004 N 19TH AVE BLDG 2
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City | DURANT
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State | OK
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Zip | 74701-3017
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Country | US
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Telephone | 580-924-5622
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Fax | 580-745-5060
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Provider Business Mailing Address
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Address Line | 1004 N 19TH AVE BLDG 2
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City | DURANT
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State | OK
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Zip | 74701-3017
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Country | US
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Telephone | 580-924-5622
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Fax | 580-745-5060
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Authorized Official
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Title or Position | HEALTH CARE PROVIDER
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Name | JENNIFER RENEE NELSON
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Credential | APRN
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Telephone | 580-924-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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