Provider Demographics
NPI:1073870382
Name:FRANCIS, FREDERICK JEREMY (APRN)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JEREMY
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 ALEXANDER DR STE 108
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-4013
Mailing Address - Country:US
Mailing Address - Phone:918-618-3647
Mailing Address - Fax:
Practice Address - Street 1:640 ALEXANDER DR STE 108
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4013
Practice Address - Country:US
Practice Address - Phone:918-618-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92665363LF0000X
OKR92665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1073870382Medicaid