Provider Demographics
NPI:1013380385
Name:MY FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MY FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:580-924-5622
Mailing Address - Street 1:1004 N 19TH AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3017
Mailing Address - Country:US
Mailing Address - Phone:580-924-5622
Mailing Address - Fax:580-745-5060
Practice Address - Street 1:1004 N 19TH AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3017
Practice Address - Country:US
Practice Address - Phone:580-924-5622
Practice Address - Fax:580-745-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-08
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty