Provider Demographics
NPI:1407106727
Name:MAYFIELD, MOLLY ANN (APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N WEIGLE AVE
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3840
Mailing Address - Country:US
Mailing Address - Phone:580-623-2233
Mailing Address - Fax:580-623-2232
Practice Address - Street 1:203 N WEIGLE AVE
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3840
Practice Address - Country:US
Practice Address - Phone:580-623-2233
Practice Address - Fax:580-623-2232
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF0812578363LF0000X
OK85992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily