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General NPI Number Information
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NPI Number | 1912333493
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Entity Type | Individual
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Provider Name | JANSON P VARGHESE APNP
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Gender | Male
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 400 S GRAND ST
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City | CRESCENT
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State | OK
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Zip | 73028-9118
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Country | US
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Telephone | 405-969-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S GRAND ST
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City | CRESCENT
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State | OK
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Zip | 73028-9118
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Country | US
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Telephone | 405-969-2818
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 92801
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 92801
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License Number State | OK
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