Organization · NPI-2
Advanced Family Care, PLLC
Family Medicine · Tulsa, OK
NPI number1104670884
StatusActive
Last updated in NPPESMay 18, 2024
Details
- NPI
- 1104670884
- Entity type
- Organization (NPI-2)
- Legal business name
- Advanced Family Care, PLLC
- Organization subpart
- No
- Enumeration date
- Apr 17, 2024
- Certification date
- May 18, 2024
- Last updated
- May 18, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
9320 S Mingo RdTulsa, OK 74133-5710
Phone 918-901-9701 · Fax 918-901-9702
Mailing address
9320 S Mingo RdTulsa, OK 74133-5710
Phone 918-921-5701 · Fax 918-901-9702
Authorized official
Kenneth Reed
Owner
9189215701
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