| Magnolia Wellness & Aesthetics | |
|
4409 N Kickapoo Ave Ste 121 Shawnee OK 74804-1225 | |
| (405) 585-0475 | |
| (855) 685-0408 |
| Full Name | Magnolia Wellness & Aesthetics |
|---|---|
| Speciality | Family Medicine |
| Location | 4409 N Kickapoo Ave Ste 121, Shawnee, Oklahoma |
| Authorized Official Name and Position | Katie Luanne Frost (NP/OWNER) |
| Authorized Official Contact | 4055850485 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Wellness & Aesthetics 4409 N Kickapoo Ave Ste 121 Shawnee OK 74804-1225 Ph: (405) 585-0475 | Magnolia Wellness & Aesthetics 4409 N Kickapoo Ave Ste 121 Shawnee OK 74804-1225 Ph: (405) 585-0475 |
| NPI Number | 1790455590 |
|---|---|
| Provider Enumeration Date | 09/14/2021 |
| Last Update Date | 09/14/2021 |
| Certification Date | 09/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790455590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
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