Provider Demographics
NPI:1215344858
Name:MOLLY A MAYFIELD APRN CNP PLLC
Entity type:Organization
Organization Name:MOLLY A MAYFIELD APRN CNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNP
Authorized Official - Phone:580-225-2663
Mailing Address - Street 1:1900 W 2ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4327
Mailing Address - Country:US
Mailing Address - Phone:580-225-2663
Mailing Address - Fax:580-225-2373
Practice Address - Street 1:1900 W 2ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4327
Practice Address - Country:US
Practice Address - Phone:580-225-2663
Practice Address - Fax:580-225-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty