Provider Demographics
NPI:1487480869
Name:IDABEL FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:IDABEL FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NACOLE
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:580-612-7748
Mailing Address - Street 1:1401 S LYNN LN
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-6859
Mailing Address - Country:US
Mailing Address - Phone:580-245-7024
Mailing Address - Fax:855-576-4102
Practice Address - Street 1:1401 S LYNN LN
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6859
Practice Address - Country:US
Practice Address - Phone:580-245-7024
Practice Address - Fax:855-576-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty