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General NPI Number Information
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NPI Number | 1104670884
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY CARE, PLLC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 05/18/2024
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Provider Practice Location Address
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Address Line | 9320 S MINGO RD
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City | TULSA
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State | OK
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Zip | 74133-5710
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Country | US
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Telephone | 918-901-9701
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Fax | 918-901-9702
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Provider Business Mailing Address
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Address Line | 9320 S MINGO RD
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City | TULSA
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State | OK
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Zip | 74133-5710
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Country | US
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Telephone | 918-921-5701
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Fax | 918-901-9702
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH REED
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Credential | MD
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Telephone | 918-921-5701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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