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General NPI Number Information
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NPI Number | 1730453846
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Entity Type | Organization
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Legal Business Name | FRELYN LOUGHRIDGE FAMILY NURSE PRACTITIONER PC
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 1005 15TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1810
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Country | US
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Telephone | 580-319-5306
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Fax | 580-223-6581
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Provider Business Mailing Address
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Address Line | 1405 4TH AVE NW # 293
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City | ARDMORE
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State | OK
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Zip | 73401-2708
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Country | US
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Telephone | 580-319-5306
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Fax | 580-223-6581
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MISS FRELYN LOUGHRIDGE
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Credential | ARNP-CNP
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Telephone | 580-319-5306
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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 | 42852
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License Number State | OK
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