Provider Demographics
NPI:1154152221
Name:HAMMONS HOMETOWN HEALTH CLINIC LLC
Entity type:Organization
Organization Name:HAMMONS HOMETOWN HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:580-513-3504
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:RINGLING
Mailing Address - State:OK
Mailing Address - Zip Code:73456-0462
Mailing Address - Country:US
Mailing Address - Phone:580-513-3504
Mailing Address - Fax:
Practice Address - Street 1:122 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:OK
Practice Address - Zip Code:73463-6203
Practice Address - Country:US
Practice Address - Phone:580-513-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty