Provider Demographics
NPI:1750066650
Name:WEEKS, NATHAN WADE (BA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:WADE
Last Name:WEEKS
Suffix:
Gender:M
Credentials:BA
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 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-5512
Mailing Address - Country:US
Mailing Address - Phone:405-380-3846
Mailing Address - Fax:
Practice Address - Street 1:1300 HOPPE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2319
Practice Address - Country:US
Practice Address - Phone:580-235-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
OK261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management