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General NPI Number Information
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NPI Number | 1124362173
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Entity Type | Organization
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Legal Business Name | THE DOWNTOWN CLINIC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 104 NORTH OKLAHOMA AVE
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City | SHAWNEE
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State | OK
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Zip | 74801-7005
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Country | US
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Telephone | 405-275-1457
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Fax |
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Provider Business Mailing Address
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Address Line | 104 NORTH OKLAHOMA AVE
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City | SHAWNEE
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State | OK
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Zip | 74801-7005
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Country | US
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Telephone | 405-275-1457
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Fax |
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Authorized Official
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Title or Position | APRN-CNP
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Name | KENDRA ANN SPEIGHT
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Credential |
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Telephone | 405-275-1457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 69925
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License Number State | OK
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