Provider Demographics
NPI:1942945910
Name:HOMETOWN PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:HOMETOWN PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:405-591-3584
Mailing Address - Street 1:890 S SANDPIPER NEST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7012
Mailing Address - Country:US
Mailing Address - Phone:405-625-3873
Mailing Address - Fax:
Practice Address - Street 1:13511 NE 23RD ST STE 140
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8625
Practice Address - Country:US
Practice Address - Phone:405-591-3584
Practice Address - Fax:405-337-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center