Individual
KISHA MARIE FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP-BC
Contact information
Practice address
119 W MAIN ST, HOMINY, OK 74035-1031
(918) 885-4640
(918) 885-4644
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5639
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
72827
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200418760A
—
OK
Enumeration date
02/17/2012
Last updated
06/07/2013
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