Individual
RUSSELL ALLEN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
138 S. MAIN ST, AFTON, OK 74331
(918) 257-8029
(918) 257-8042
Mailing address
1190 RYNES RD, DECATUR, TN 37322-7420
(423) 718-8134
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0123709
OK
363LF0000X
Family Nurse Practitioner
APN0000020958
TN
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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