# FIRST CHOICE WELLNESS CENTER LLC

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

## Provider details

- **NPI number:** 1811187800
- **Authorized official:** ADDIE BETH GRATZ ARNP (OWNER)
- **Authorized official phone:** (580) 371-0500

## Contact information

- **Practice address:** 9 N MAIN, KINGSTON, OK 73439-7343
- **Practice address phone:** (158) 056-4050
- **Practice address fax:** (580) 564-0500
- **Mailing address:** PO BOX 849, TISHOMINGO, OK 73460-0849
- **Mailing address phone:** (580) 564-0500
- **Mailing address fax:** (580) 564-0250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 7588 | OK | Yes |
| 364SF0001X | Family Health Clinical Nurse Specialist | R0067529 | OK | — |

## Other

- **Enumeration date:** 07/26/2007
- **Last updated:** 03/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200117140A | — | OK |