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General NPI Number Information
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NPI Number | 1518458272
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Entity Type | Organization
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Legal Business Name | TRAIL CREEK WELLNESS PC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1001 HOSPITAL CIR
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City | KINGFISHER
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State | OK
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Zip | 73750-5002
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Country | US
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Telephone | 405-375-7935
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Fax | 405-375-7937
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Provider Business Mailing Address
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Address Line | 1001 HOSPITAL CIR
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City | KINGFISHER
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State | OK
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Zip | 73750-5002
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Country | US
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Telephone | 405-375-7935
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Fax | 405-375-7937
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Authorized Official
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Title or Position | NURSE PRACTITIONER / OWNER
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Name | RACHEL M CAMERON
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Credential | APRN-CNP
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Telephone | 405-368-5460
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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 | 66837
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License Number State | OK
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