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1316722119
JACK WADE LETHERMON
CLAREMORE, OK
NPI
1316722119
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: OK 214986)
Enumeration Date
2023-08-29
Last Update Date
2024-04-08
Business Address
Dr. JACK WADE LETHERMON DNP PMHNP
505 W 1ST ST
CLAREMORE, OK 74017-7803
Phone number: 918-606-5225
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Mailing Address
Dr. JACK WADE LETHERMON DNP PMHNP
904 S DIVISION ST
SAPULPA, OK 74066-5706
Phone number: 918-606-5225
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