Provider Demographics
NPI:1063648897
Name:WORKMAN, TERRY L (APRN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0179
Mailing Address - Country:US
Mailing Address - Phone:918-967-4560
Mailing Address - Fax:918-967-4582
Practice Address - Street 1:17 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4010
Practice Address - Country:US
Practice Address - Phone:918-689-3333
Practice Address - Fax:918-689-3330
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0054479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054500EMedicaid