Provider Demographics
NPI:1679141626
Name:FORD, CATHERINE MARIE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MARIE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 W LOCUST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3276
Mailing Address - Country:US
Mailing Address - Phone:918-696-4064
Mailing Address - Fax:918-696-4170
Practice Address - Street 1:1401 W LOCUST ST STE 102
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3276
Practice Address - Country:US
Practice Address - Phone:918-696-4064
Practice Address - Fax:918-696-4170
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF11200878363LF0000X
OK200505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily