Individual
CARTER REESE WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
308 E DOWNING ST, TAHLEQUAH, OK 74464-3014
(918) 960-7852
Mailing address
32090 E 747 RD, WAGONER, OK 74467-9446
(918) 348-1439
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
04/10/2023
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