Provider Demographics
NPI:1649412263
Name:CROSS, GLENDA GENE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:GENE
Last Name:CROSS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E 24TH
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460
Mailing Address - Country:US
Mailing Address - Phone:580-371-2343
Mailing Address - Fax:580-371-2451
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-6562
Practice Address - Country:US
Practice Address - Phone:580-564-7885
Practice Address - Fax:580-564-7902
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK67070363LF0000X
OKR0067070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily