Provider Demographics
NPI:1477097699
Name:URGENT CARE OF PAULS VALLEY APRN-CNP LLC
Entity Type:Organization
Organization Name:URGENT CARE OF PAULS VALLEY APRN-CNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:405-238-3900
Mailing Address - Street 1:2000 W GRANT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-9233
Mailing Address - Country:US
Mailing Address - Phone:405-238-3900
Mailing Address - Fax:405-238-3903
Practice Address - Street 1:2000 W GRANT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-9233
Practice Address - Country:US
Practice Address - Phone:405-238-3900
Practice Address - Fax:405-238-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care