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General NPI Number Information
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NPI Number | 1811880487
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Entity Type | Individual
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Provider Name | WILLIAM WYNN
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1402 N FLORENCE AVE
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City | CLAREMORE
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State | OK
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Zip | 74017-3159
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Country | US
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Telephone | 918-608-0830
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Fax |
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Provider Business Mailing Address
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Address Line | 3212 BOB O LINK LN
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City | DENTON
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State | TX
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Zip | 76209-4808
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Country | US
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Telephone | 817-881-2516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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