Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 135841 | OK |
NPI | 1013542406 |
---|---|
Provider Name | Jorge Cardenas |
First Address | Vernon, TX 76385-0229 |
Second Address | Altus, OK 73521-5755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2020 |
Last Update Date | 13/05/2020 |