1598942443 NPI number — LOUANN M MARTIN ARNP

Table of content: LOUANN M MARTIN ARNP (NPI 1598942443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598942443 NPI number — LOUANN M MARTIN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
LOUANN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEWART
Provider Other First Name:
LOUANN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598942443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1415 N WATTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYRE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73662-1310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-928-2044
Provider Business Mailing Address Fax Number:
580-928-5660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODWARD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73801-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-571-8048
Provider Business Practice Location Address Fax Number:
580-571-8085
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R0064327 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 64327 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200135740A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com