# AETHERIUS MEDICAL LLC

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

## Provider details

- **NPI number:** 1851103063
- **Authorized official:** MRS. KRYSTEN MESCAN (OWNER - FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (405) 300-1476

## Contact information

- **Practice address:** 408 N MAIN ST, NOBLE, OK 73068-9574
- **Practice address phone:** (405) 339-5261
- **Mailing address:** 408 N MAIN ST, NOBLE, OK 73068-9574
- **Mailing address phone:** (405) 300-1476

## Taxonomy

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

## Other

- **Enumeration date:** 01/23/2025
- **Last updated:** 03/18/2025