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NPI Code Detail

MEDICARE: MRS. MARTHA WISEHART HERNANDEZ APRN,CNS,BC

MEDICARE: MRS. MARTHA WISEHART HERNANDEZ APRN,CNS,BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerR0037249OK

General Provider Information

NPI Number : 1811031016
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARTHA WISEHART HERNANDEZ APRN,CNS,BC
Provider Business Mailing Address
First Line : PO BOX 189
Second Line :
City : ARDMORE
State : OK
Zip : 73402-0189
Country : US
Telephone Number : 580-319-7305
Fax Number : 580-319-7305
Provider Business Practice Location Address
First Line : 301 W 4TH ST
Second Line :
City : ADA
State : OK
Zip : 74820-3411
Country : US
Telephone Number : 580-436-2690
Fax Number : 580-436-5539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 07/10/2023

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