Provider Demographics
NPI:1780892299
Name:TRANTHAM, ELLEN REESER (ARNP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:REESER
Last Name:TRANTHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-3427
Mailing Address - Country:US
Mailing Address - Phone:580-762-1198
Mailing Address - Fax:
Practice Address - Street 1:KAY COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:433 FAIRVIEW
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-762-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0029460363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health