| Deer Creek Family Healthcare And Wellness Clinic Llc | |
|
19401 N. Portland Edmond OK 73012 | |
| (405) 812-8208 | |
| Not Available |
| Full Name | Deer Creek Family Healthcare And Wellness Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 19401 N. Portland, Edmond, Oklahoma |
| Authorized Official Name and Position | Kim Knox (NURSE PRACTITIONER / OWNER) |
| Authorized Official Contact | 4058128208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deer Creek Family Healthcare And Wellness Clinic Llc 19401 N. Portland Edmond OK 73012 Ph: (405) 812-8208 | Deer Creek Family Healthcare And Wellness Clinic Llc 19401 N. Portland Edmond OK 73012 Ph: (405) 812-8208 |
| NPI Number | 1003227414 |
|---|---|
| Provider Enumeration Date | 05/20/2014 |
| Last Update Date | 06/27/2014 |
| Medicare PECOS PAC ID | 6709007099 |
|---|---|
| Medicare Enrollment ID | O20141030001805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003227414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kim B Knox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871554808 PECOS PAC ID: 8921077215 Enrollment ID: I20041004000142 |
| Provider Name | David R Allen |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1154398410 PECOS PAC ID: 6002976594 Enrollment ID: I20081113000269 |
| Provider Name | Kimberly A Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932340478 PECOS PAC ID: 8729242656 Enrollment ID: I20120605000727 |
| Provider Name | Nana B Tetteh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346809894 PECOS PAC ID: 7214262252 Enrollment ID: I20190712000207 |
| Provider Name | Genevieve K Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821654260 PECOS PAC ID: 0840527735 Enrollment ID: I20190815001454 |
| Provider Name | Kimberly Mccoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629773155 PECOS PAC ID: 7810354362 Enrollment ID: I20230530000013 |
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