Individual
SERENA BROOKE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
828 A ST NW, MIAMI, OK 74354-4605
(918) 999-9339
(918) 238-9990
Mailing address
58700 E 190 RD, FAIRLAND, OK 74343-2500
(918) 961-1658
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
89085
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200461260A
—
OK
05
—
200468380C
—
OK
Enumeration date
10/10/2012
Last updated
09/27/2025
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