Fresh Medical LLC
Nurse Practitioner in Weatherford, OK. Organization (NPI-2).
NPI number1740664580
StatusActive
Last updated in NPPESJul 10, 2015
Details
- NPI
- 1740664580
- Entity type
- Organization (NPI-2)
- Legal business name
- Fresh Medical LLC
- Organization subpart
- No
- Enumeration date
- Jul 10, 2015
- Last updated
- Jul 10, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | R0092194 | OK | Yes |
| 363A00000X | Physician Assistant | 817 | OK |
Practice location
4200 Carriage WayWeatherford, OK 73096-9614
Phone 580-774-2214 · Fax 580-774-2843
Mailing address
4200 Carriage WayWeatherford, OK 73096-9614
Phone 580-774-2214 · Fax 580-774-2843
Authorized official
Ashley Dawn Morris
Office Adminstrator
5807742214
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