Provider Demographics
NPI:1417317140
Name:WEATHERFORD, RENEE A (NP-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637-5084
Mailing Address - Country:US
Mailing Address - Phone:918-642-3291
Mailing Address - Fax:918-642-3694
Practice Address - Street 1:40 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:OK
Practice Address - Zip Code:74637-5084
Practice Address - Country:US
Practice Address - Phone:918-642-3291
Practice Address - Fax:918-642-3694
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72461363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily