Organization
MINDCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK LETHERMON APRN (NURSE PRACTITIONER)
(918) 606-5225
Entity
Organization
Contact information
Practice address
904 S DIVISION ST, SAPULPA, OK 74066-5706
(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
—
—
Other
Enumeration date
01/16/2024
Last updated
01/16/2024
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