Provider Demographics
NPI:1164831574
Name:DENNIS, MARY MELINDA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MELINDA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 N INDIAN MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-9236
Mailing Address - Country:US
Mailing Address - Phone:405-207-9800
Mailing Address - Fax:405-207-9898
Practice Address - Street 1:105 N INDIAN MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-9236
Practice Address - Country:US
Practice Address - Phone:405-207-9800
Practice Address - Fax:405-207-9898
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK89347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily