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General NPI Number Information
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NPI Number | 1023348059
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Entity Type | Organization
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Legal Business Name | WELLSTON FAMILY MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 309 W. 2ND ST.
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City | WELLSTON
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State | OK
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Zip | 74881
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Country | US
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Telephone | 405-356-2998
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Fax | 405-258-0498
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | WELLSTON
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State | OK
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Zip | 74881-0098
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Country | US
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Telephone | 405-356-2998
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Fax | 405-258-0498
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Authorized Official
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Title or Position | ARNP
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Name | MRS. SHERRY DIANN MITCHELL
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Credential | FNP-BC
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Telephone | 405-258-3971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R0080778
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License Number State | OK
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