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General NPI Number Information
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NPI Number | 1336253731
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Entity Type | Individual
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Provider Name | RUTH ELAINE FEREDAY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 107 E POST AVE
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City | COALGATE
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State | OK
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Zip | 74538-3004
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Country | US
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Telephone | 580-927-2828
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Fax | 580-258-3000
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Provider Business Mailing Address
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Address Line | 610 E 24TH ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-3245
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Country | US
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Telephone | 580-371-2343
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Fax | 580-371-3614
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 950
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License Number State | OK
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