Provider Demographics
NPI:1366196560
Name:CROSSROADS FAMILY HEALTH, LLC
Entity type:Organization
Organization Name:CROSSROADS FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:580-618-5686
Mailing Address - Street 1:333 W MAIN ST STE 245
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6300
Mailing Address - Country:US
Mailing Address - Phone:580-618-5686
Mailing Address - Fax:949-798-7827
Practice Address - Street 1:333 W MAIN ST STE 245
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6300
Practice Address - Country:US
Practice Address - Phone:580-618-5686
Practice Address - Fax:949-798-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty