GWEN FUENTES MD PEDIATRIC CLINIC (NPI# 1083830608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083830608 |
| Entity Type | Organization |
| Organization Name | GWEN FUENTES MD PEDIATRIC CLINIC |
| Practice Address |
919 15th Ave Nw Ardmore OK 73401-1809 |
| Practice Telephone | 5802235693 |
| Practice Fax Number | 5802238909 |
| Mailing Telephone | 5802235693 |
| Mailing Fax Number | 5802238909 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-01-30 |
| Authorized Official Name | DR. GWEN CANARIAS FUENTES (OWNER) |
| Authorized Official Telephone | 5802235693 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 13171 | OK | Allopathic & Osteopathic Physicians |
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
13171 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100209330C | 05 | |
| OK | 100209330A | 05 |
| Street Address |
919 15TH AVE NW |
| City | ARDMORE |
| State | OK |
| Zip Code | 73401-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013914324 | Gwen Canarias Fuentes | Pediatrics | 919 15th Ave Nw, Ardmore, OK 73401-1809 | 2005-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391452 | Abbie Deeann Mclemore | Nurse Practitioner | 915 10th Ave, Ardmore, OK 73401 | 2019-11-25 |
| 1790349991 | Shirley Denise Brown | Licensed Psychiatric Technician | 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 | 2019-04-24 |
| 1427512359 | Billy Joe Oshields | Case Manager/Care Coordinator | 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 | 2019-01-24 |
| 1174007595 | Tawnya Dawn Peery | Nurse Practitioner | 1108 W. Walnut Drive, Ardmore, OK 73401 | 2018-09-21 |
| 1679055016 | Teresa Marie Hernandez | Behavior Technician | 1219 K St. Nw, Ardmore, OK 73401 | 2018-09-01 |
| 1063991974 | Sawyer Rae Shamburger | Occupational Therapy Assistant | 208 North Praire St, Pilot Point, TX 73401 | 2018-08-10 |
| 1417473521 | Chelsye Bacon | Peer Specialist | 905 Holiday Drive, Ardmore, OK 73401 | 2017-08-21 |
| 1003279746 | Jeni Presley | Marriage & Family Therapist | Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 | 2016-03-31 |
| 1982080909 | Alison Hill | Pharmacist | 1111 N. Commerce, Ardmore, OK 73401 | 2015-07-31 |
| 1316346547 | Olivia Larae Carrell | Counselor | 15 Monroe Street Ne, Ardmore, OK 73401 | 2014-08-13 |
| Find all providers in zip 73401 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699811802 | Mental Health Services of Southern Oklahoma | Clinic/Center | 2530 S Commerce, Bldg A, Ardmore, OK 73401-5519 | 2007-01-29 |
| 1710053178 | Osu Center for Health Sciences | Clinic/Center | 1023 15th Ave Nw, Ardmore, OK 73401-1810 | 2006-11-28 |
| 1730255316 | Osu Center for Health Sciences | Clinic/Center | 800 Isabel St, Ardmore, OK 73401-5118 | 2006-11-27 |
| 1811063464 | Osu Center for Health Sciences | Clinic/Center | 800 Isabel St, Ardmore, OK 73401-5118 | 2006-11-27 |
| 1952476251 | Osu Center for Health Sciences | Clinic/Center | 1104 Walnut Dr, Ardmore, OK 73401-2353 | 2006-11-21 |
| 1013082791 | Osu Center for Health Sciences | Clinic/Center | 731 12th Ave Nw, Suite 201, Ardmore, OK 73401-5761 | 2006-11-21 |
| 1932273042 | Osu Center for Health Sciences | Clinic/Center | 830 16th Ave Nw, Ardmore, OK 73401-1818 | 2006-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093312548 | Prime Health Associates, Pllc | Clinic/Center | 2511 Alexa Ave, Edmond, OK 73034-3458 | 2020-10-07 |
| 1598387524 | Thomas E. Cashero Md LLC | Clinic/Center | 90 N 30th St Ste 5, Clinton, OK 73601-3100 | 2020-05-13 |
| 1184271793 | Healthy Skin Dermatology of Oklahoma Pllc | Clinic/Center | 13933 Technology Dr Ste B, Oklahoma City, OK 73134-1053 | 2019-08-20 |
| 1922572809 | Endovascular Consulting Solutions | Clinic/Center | 1705 E 19th St Ste 410, Tulsa, OK 74104-5415 | 2019-01-14 |
| 1831610641 | Scot A Sullivan Md PC | Clinic/Center | 2020 E 15th St Ste B, Edmond, OK 73013-6749 | 2017-06-30 |
| 1053862102 | Okc Neurology-catherine E Porter Md, Pllc | Clinic/Center | 6701 W Hefner Rd Ste B, Oklahoma City, OK 73162-4706 | 2016-10-24 |
| 1730584509 | Digital Diagnostic Solutions LLC | Clinic/Center | 5017 S Frontage Road, Tulsa, OK 74107-8976 | 2014-10-23 |
| 1891102331 | Panhandle Counseling and Health Center, Inc. | Clinic/Center | 5170 Patricia Blvd, Guymon, OK 73942-0000 | 2014-07-16 |
| 1922350719 | Allergy Arts of Oklahoma Pllc | Clinic/Center | 3300 Nw 56th St Ste 100, Oklahoma City, OK 73112-4538 | 2012-10-04 |
| 1255699112 | Meghan E. Scears, Md, Pllc | Clinic/Center | 808 24th Ave Nw Ste 202, Norman, OK 73069-6204 | 2012-04-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.