Individual
LARRY WALTER CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
57523 MOCCASIN TRAIL RD, PRAGUE, OK 74864-1143
(405) 567-0054
(405) 567-0055
Mailing address
57523 MOCCASIN TRAIL RD, PRAGUE, OK 74864-1143
(405) 567-0054
(405) 567-0055
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0027933
OK
Other
Enumeration date
10/20/2025
Last updated
10/24/2025
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