Provider Demographics
NPI:1225245194
Name:HULSEY, AMY DANIELLE (CNS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DANIELLE
Last Name:HULSEY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DANIELLE
Other - Last Name:KLUGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:6800 NW 39TH EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008
Mailing Address - Country:US
Mailing Address - Phone:405-789-6711
Mailing Address - Fax:405-789-5978
Practice Address - Street 1:6800 NW 39TH EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008
Practice Address - Country:US
Practice Address - Phone:405-789-6711
Practice Address - Fax:405-789-5978
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0066211364SP0200X
OK66211364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200115170AMedicaid