Individual
TARA R HENTHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 W GRAND AVE, CHICKASHA, OK 73018-5862
(405) 224-0053
Mailing address
416 N MAIN ST, ALTUS, OK 73521-3108
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
102945
OK
Other
Enumeration date
10/24/2019
Last updated
12/20/2023
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