Provider Demographics
NPI:1952070013
Name:POCOLA FAMILY CLINIC
Entity Type:Organization
Organization Name:POCOLA FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:539-245-2062
Mailing Address - Street 1:503 N POCOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:POCOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74902-3123
Mailing Address - Country:US
Mailing Address - Phone:153-924-5206
Mailing Address - Fax:539-245-2078
Practice Address - Street 1:503 N POCOLA BLVD
Practice Address - Street 2:
Practice Address - City:POCOLA
Practice Address - State:OK
Practice Address - Zip Code:74902-3123
Practice Address - Country:US
Practice Address - Phone:539-245-2062
Practice Address - Fax:539-245-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty