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General NPI Number Information
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NPI Number | 1518226562
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Entity Type | Organization
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Legal Business Name | FAMILY 1ST HEALTH CARE OF KINGFISHER APRN-CNP, PLLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 1610 S MAIN ST
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City | KINGFISHER
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State | OK
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Zip | 73750-4600
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Country | US
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Telephone | 405-375-5222
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Fax | 405-375-5234
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Provider Business Mailing Address
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Address Line | 1610 S MAIN ST
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City | KINGFISHER
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State | OK
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Zip | 73750-4600
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Country | US
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Telephone | 405-375-5222
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Fax | 405-375-5234
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MELISSA MEAGAN STATES
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Credential | APRN-CNP
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Telephone | 405-375-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | R0071397
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License Number State | OK
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