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General NPI Number Information
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NPI Number | 1073967246
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Entity Type | Individual
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Provider Name | MARYSUE ELIZABETH FARRIS APRN
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 2900 S TELEPHONE RD SUITE 250
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City | MOORE
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State | OK
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Zip | 73160-2968
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Country | US
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Telephone | 405-237-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 35737 HAMILTON RD
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City | WANETTE
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State | OK
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Zip | 74878-6025
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Country | US
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Telephone | 405-808-6160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | R0050272
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0816002
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 50272
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License Number State | OK
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