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General NPI Number Information
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NPI Number | 1134827660
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Entity Type | Organization
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Legal Business Name | ALVA HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 515 COLLEGE AVE STE 3
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City | ALVA
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State | OK
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Zip | 73717-2230
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Country | US
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Telephone | 580-747-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 515 COLLEGE AVE STE 3
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City | ALVA
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State | OK
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Zip | 73717-2230
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Country | US
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Telephone | 580-747-0296
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Fax |
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Authorized Official
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Title or Position | LEAD PROVIDER
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Name | MR. JEREMY D LOGSDON
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Credential | APRN
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Telephone | 580-747-0296
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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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