Provider Demographics
NPI:1639830573
Name:THUMMEL, WILLIAM KARL (APRN-FNP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KARL
Last Name:THUMMEL
Suffix:
Gender:M
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E LANSING ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2429
Mailing Address - Country:US
Mailing Address - Phone:918-258-9111
Mailing Address - Fax:
Practice Address - Street 1:1816 N 12TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9392
Practice Address - Country:US
Practice Address - Phone:918-724-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0112640163WG0000X
OK206441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice