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General NPI Number Information
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NPI Number | 1689424079
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Entity Type | Organization
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Legal Business Name | CONNECTING CARE CLINIC, LLC
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 11225 W RENO AVE
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City | YUKON
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State | OK
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Zip | 73099-7569
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Country | US
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Telephone | 405-633-3419
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Fax |
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Provider Business Mailing Address
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Address Line | 4062 NW 36TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2988
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Country | US
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Telephone | 316-249-3265
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RENAE MARIE KRAFT
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Credential | PHARMD
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Telephone | 405-633-3419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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