Individual
JENNIFER DANIELLE GOUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2036 S MILLER LN, CATOOSA, OK 74015-1520
(918) 739-4552
Mailing address
1001 E 18TH ST, GROVE, OK 74344-2907
(918) 786-2243
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
97758
OK
Other
Enumeration date
08/30/2018
Last updated
07/29/2022
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