Provider Demographics
NPI:1811031016
Name:HERNANDEZ, MARTHA WISEHART (APRN,CNS,BC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:WISEHART
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:APRN,CNS,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0189
Mailing Address - Country:US
Mailing Address - Phone:580-319-7305
Mailing Address - Fax:580-319-7305
Practice Address - Street 1:301 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3411
Practice Address - Country:US
Practice Address - Phone:580-436-2690
Practice Address - Fax:580-436-5539
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0037249363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health