Individual
VICKI C LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
608 S HESTER ST, STILLWATER, OK 74074-4516
(405) 377-8000
(405) 377-8040
Mailing address
608 S HESTER ST, STILLWATER, OK 74074-4516
(405) 377-8000
(405) 377-8040
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
OK725
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200235260A
—
OK
Enumeration date
04/20/2006
Last updated
11/05/2009
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