Provider Demographics
NPI:1114984150
Name:AVERY, ROBIN N (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:N
Last Name:AVERY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1800 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6224
Mailing Address - Country:US
Mailing Address - Phone:405-732-7119
Mailing Address - Fax:405-732-7120
Practice Address - Street 1:1800 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6224
Practice Address - Country:US
Practice Address - Phone:405-732-7119
Practice Address - Fax:405-732-7120
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071020AMedicaid
Q59256Medicare UPIN
OK200071020AMedicaid