Individual
JUDY GOFORTH-PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 421-6283
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
29185
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29185
OKLAHOMA LICENSE
OK
Enumeration date
12/14/2010
Last updated
08/07/2014
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