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General NPI Number Information
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NPI Number | 1942945910
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Entity Type | Organization
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Legal Business Name | HOMETOWN PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 13511 NE 23RD ST STE 140
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City | CHOCTAW
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State | OK
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Zip | 73020-8625
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Country | US
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Telephone | 405-591-3584
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Fax | 405-337-9596
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Provider Business Mailing Address
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Address Line | 890 S SANDPIPER NEST
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City | CHOCTAW
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State | OK
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Zip | 73020-7012
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Country | US
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Telephone | 405-625-3873
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Fax |
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Authorized Official
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Title or Position | MEMBER/NURSE PRACTITIONER
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Name | CANDACE D HERRIN
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Credential | APRN-CNP
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Telephone | 405-591-3584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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