Individual
LUCILLE WAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2510 CHICKASAW BLVD, ARDMORE, OK 73401-1341
(580) 226-8181
(580) 421-6283
Mailing address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
568755
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TEZ007
MEDICARE IDENTIFICATION N
OK
Enumeration date
07/10/2007
Last updated
07/10/2007
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