Provider Demographics
NPI:1720496904
Name:HOOKER MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:HOOKER MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:580-652-1100
Mailing Address - Street 1:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:HOOKER
Mailing Address - State:OK
Mailing Address - Zip Code:73945-1092
Mailing Address - Country:US
Mailing Address - Phone:580-652-1100
Mailing Address - Fax:580-652-1102
Practice Address - Street 1:101 W. GLAYDAS AVE.
Practice Address - Street 2:
Practice Address - City:HOOKER
Practice Address - State:OK
Practice Address - Zip Code:73945-1092
Practice Address - Country:US
Practice Address - Phone:580-652-1100
Practice Address - Fax:580-652-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74479261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care