Individual
DR. JACK WADE LETHERMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP PMHNP
Contact information
Practice address
505 W 1ST ST, CLAREMORE, OK 74017-7803
(918) 606-5225
Mailing address
904 S DIVISION ST, SAPULPA, OK 74066-5706
(918) 606-5225
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
214986
OK
Other
Enumeration date
08/29/2023
Last updated
04/08/2024
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