Provider Demographics
NPI:1124182944
Name:ARNOLD, LATRICIA GENE (DO)
Entity Type:Individual
Prefix:DR
First Name:LATRICIA
Middle Name:GENE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LATRICIA
Other - Middle Name:GENE
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:100 MCDOUGAL DR
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-2899
Mailing Address - Country:US
Mailing Address - Phone:405-379-4200
Mailing Address - Fax:405-379-4284
Practice Address - Street 1:1401 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-5097
Practice Address - Country:US
Practice Address - Phone:405-257-3396
Practice Address - Fax:405-257-6908
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4010207Q00000X, 207Q00000X
ALDO.1358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200006420AMedicaid
OK200006420AMedicaid
OKOK402157Medicare PIN