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General NPI Number Information
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NPI Number | 1619680857
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Entity Type | Organization
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Legal Business Name | WATTS WELLNESS WORTH MEDICAL CLINIC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 902 S PINE ST
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City | STILLWATER
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State | OK
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Zip | 74074-5453
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Country | US
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Telephone | 918-221-0896
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Fax | 405-402-3245
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Provider Business Mailing Address
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Address Line | 357620 E 760 RD
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City | CUSHING
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State | OK
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Zip | 74023-6710
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Country | US
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Telephone | 405-301-7581
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Fax | 405-402-3245
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BRANDI RANAY WATTS
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Credential | APRN, FNP-BC
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Telephone | 405-301-7581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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