# COUNTRY CARE FAMILY CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063058840
- **Authorized official:** SHERRY DIANN MITCHELL APRN-CNP (OWNER)
- **Authorized official phone:** (405) 532-1943

## Contact information

- **Practice address:** 304 W 2ND ST, WELLSTON, OK 74881-9496
- **Practice address phone:** (405) 473-7053
- **Practice address fax:** (405) 832-1144
- **Mailing address:** PO BOX 5862, EDMOND, OK 73083-5862

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2019
- **Last updated:** 12/30/2019