Organization
SKINNER FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TENIA LADONNA SKINNER DO (PHYSICIAN)
(405) 641-6628
Entity
Organization
Contact information
Practice address
129 N 3RD AVE STE C, PURCELL, OK 73080
(405) 641-6628
(405) 527-8669
Mailing address
129 N 3RD AVE STE C, PURCELL, OK 73080-4246
(405) 641-6628
(405) 527-6569
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200204740A
—
OK
Enumeration date
05/31/2018
Last updated
09/05/2018
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