Provider Demographics
NPI:1639559412
Name:ANDERSON, GINGER (APRN CNP)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N CLARENCE NASH BLVD
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3636
Mailing Address - Country:US
Mailing Address - Phone:580-623-4954
Mailing Address - Fax:580-623-4980
Practice Address - Street 1:407 N CLARENCE NASH BLVD
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3636
Practice Address - Country:US
Practice Address - Phone:580-623-4954
Practice Address - Fax:580-623-4980
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0098200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily