Individual
DONAVON BALDRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1000
Mailing address
204 TOMMYE LN, TAHLEQUAH, OK 74464-4174
(918) 774-7326
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201015
OK
363LF0000X
Family Nurse Practitioner
Primary
201015
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201188720A
—
OK
Enumeration date
07/25/2023
Last updated
10/17/2025
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