Organization
FAITH FAMILY CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATTI WHEATON ARNP (OWNER)
(918) 291-0004
Entity
Organization
Contact information
Practice address
1239 W MAIN ST, JENKS, OK 74037-2311
(918) 291-0004
(918) 296-3911
Mailing address
1239 W MAIN ST, JENKS, OK 74037-2311
(918) 291-0004
(918) 296-3911
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0049248
OK
363LW0102X
Women's Health Nurse Practitioner
R0049248
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000065310B
INSURE OKLAHOMA
OK
Enumeration date
04/01/2008
Last updated
04/01/2008
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