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General NPI Number Information
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NPI Number | 1871133835
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Entity Type | Individual
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Provider Name | JEANNIE MARIE WYRICK DNP, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 4303 PITMAN ST
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City | FORT SILL
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State | OK
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Zip | 73503-4473
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Country | US
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Telephone | 580-678-3856
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Fax |
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Provider Business Mailing Address
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Address Line | 4303 PITMAN ST
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City | FORT SILL
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State | OK
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Zip | 73503-4473
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Country | US
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Telephone | 580-585-5600
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 89845
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License Number State | OK
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