Provider Demographics
NPI:1932165768
Name:LOUGHRIDGE, FRELYN G (APRN-CNP)
Entity type:Individual
Prefix:
First Name:FRELYN
Middle Name:G
Last Name:LOUGHRIDGE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 4TH AVE NW # 293
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:580-319-5305
Mailing Address - Fax:580-223-6581
Practice Address - Street 1:1025 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1810
Practice Address - Country:US
Practice Address - Phone:580-319-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0042852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0042852OtherAPRN-CNP OKLAHOMA LICENSE
OKP90273Medicare UPIN