Organization
ANDERSON FAMILY MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLY DAWN ANDERSON DNP, APRN-CNP (APRN)
(918) 564-2726
Entity
Organization
Contact information
Practice address
2505 N BROADWAY ST, POTEAU, OK 74953-2050
(918) 564-2726
(918) 564-2732
Mailing address
2505 N BROADWAY ST, POTEAU, OK 74953-2050
(918) 564-2726
(918) 564-2732
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200571200A
—
OK
Enumeration date
08/24/2020
Last updated
07/17/2022
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