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General NPI Number Information
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NPI Number | 1881946259
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Entity Type | Individual
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Provider Name | SERENA BROOKE WILSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 09/27/2025
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Provider Practice Location Address
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Address Line | 828 A ST NW
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City | MIAMI
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State | OK
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Zip | 74354-4605
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Country | US
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Telephone | 918-999-9339
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Fax | 918-238-9990
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Provider Business Mailing Address
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Address Line | 58700 E 190 RD
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City | FAIRLAND
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State | OK
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Zip | 74343-2500
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Country | US
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Telephone | 918-961-1658
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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 | 89085
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License Number State | OK
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