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General NPI Number Information
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NPI Number | 1710311154
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Entity Type | Organization
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Legal Business Name | ACADIA FAMILY MEDICAL CLINIC L.L.C.
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 05/18/2014
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Provider Practice Location Address
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Address Line | 230 E 5TH ST
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City | PAWHUSKA
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State | OK
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Zip | 74056-5204
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Country | US
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Telephone | 918-287-9112
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Fax | 918-287-9113
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Provider Business Mailing Address
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Address Line | 230 E 5TH ST
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City | PAWHUSKA
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State | OK
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Zip | 74056-5204
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Country | US
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Telephone | 918-287-9112
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Fax | 918-287-9113
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | THERESA A FLOWERETTE
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Credential | ARNP, NP-C
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Telephone | 918-287-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 70154
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License Number State | OK
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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 | 27629
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 27629
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 3512416926
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License Number State | OK
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