Individual
JONATHAN WILLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 W COMMERCIAL ST, BROKEN ARROW, OK 74012-4012
(918) 887-8300
Mailing address
109 W COMMERCIAL ST, BROKEN ARROW, OK 74012-4012
(918) 887-8300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0133031
OK
363L00000X
Nurse Practitioner
Primary
225851
OK
Other
Enumeration date
06/30/2025
Last updated
12/18/2025
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