Provider Demographics
NPI:1760947022
Name:WINTERS, EMILY LAUREN (APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:WINTERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LAUREN
Other - Last Name:UNDERHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:19055 STATE HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:MEDICINE PARK
Mailing Address - State:OK
Mailing Address - Zip Code:73557
Mailing Address - Country:US
Mailing Address - Phone:580-595-5503
Mailing Address - Fax:
Practice Address - Street 1:19055 STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:MEDICINE PARK
Practice Address - State:OK
Practice Address - Zip Code:73557
Practice Address - Country:US
Practice Address - Phone:580-595-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK112624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty