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General NPI Number Information
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NPI Number | 1194405308
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Entity Type | Organization
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Legal Business Name | RESTORE FAMILY MEDICAL CLINIC II
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 111 N 3RD ST
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City | HUGO
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State | OK
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Zip | 74743-4001
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Country | US
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Telephone | 580-372-2819
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N 3RD ST
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City | HUGO
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State | OK
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Zip | 74743-4001
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Country | US
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Telephone | 580-372-2819
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. KENDALL M PHILLIPS
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Credential | FNP-BC
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Telephone | 580-982-6044
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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 |
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License Number State |
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