Individual
HERNDON GIDEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
12 E MACARTHUR ST, SHAWNEE, OK 74804-2135
(405) 275-1001
Mailing address
4705 GRACELANN, SHAWNEE, OK 74804-2372
(580) 380-1483
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
82547
OK
Other
Enumeration date
05/06/2015
Last updated
05/06/2015
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