| NPI | 1164181244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN D WILSON Cmo 405-631-0483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2025-03-12 |