Provider Demographics
NPI:1730453846
Name:FRELYN LOUGHRIDGE FAMILY NURSE PRACTITIONER PC
Entity type:Organization
Organization Name:FRELYN LOUGHRIDGE FAMILY NURSE PRACTITIONER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:FRELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUGHRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-CNP
Authorized Official - Phone:580-319-5306
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:580-319-5306
Mailing Address - Fax:580-223-6581
Practice Address - Street 1:1005 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:580-319-5306
Practice Address - Fax:580-223-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty