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General NPI Number Information
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NPI Number | 1912713348
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Entity Type | Organization
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Legal Business Name | TOTAL FAMILY HEALTHCARE CLINIC PLLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 2103 E WASHINGTON ST
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City | IDABEL
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State | OK
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Zip | 74745-7861
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Country | US
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Telephone | 580-212-9872
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 E WASHINGTON ST
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City | IDABEL
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State | OK
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Zip | 74745-7861
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Country | US
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Telephone | 580-286-2299
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Fax | 888-355-6329
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELISSA A PIERCE
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Credential | APRN FNP-C
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Telephone | 580-212-9872
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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 |
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License Number State |
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