Provider Demographics
NPI:1619680857
Name:WATTS WELLNESS WORTH MEDICAL CLINIC
Entity Type:Organization
Organization Name:WATTS WELLNESS WORTH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:RANAY
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:405-301-7581
Mailing Address - Street 1:357620 E 760 RD
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-6710
Mailing Address - Country:US
Mailing Address - Phone:405-301-7581
Mailing Address - Fax:405-402-3245
Practice Address - Street 1:902 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5453
Practice Address - Country:US
Practice Address - Phone:918-221-0896
Practice Address - Fax:405-402-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1336657022OtherNPI