Provider Demographics
NPI:1922788363
Name:FARMER, JOSHUA KEITH
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KEITH
Last Name:FARMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14430 NS 3500
Mailing Address - Street 2:
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849-4901
Mailing Address - Country:US
Mailing Address - Phone:405-207-7477
Mailing Address - Fax:
Practice Address - Street 1:14430 NS 3500
Practice Address - Street 2:
Practice Address - City:KONAWA
Practice Address - State:OK
Practice Address - Zip Code:74849-4901
Practice Address - Country:US
Practice Address - Phone:580-925-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty