Provider Demographics
NPI:1265853758
Name:BLISS, COTY J (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:COTY
Middle Name:J
Last Name:BLISS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:COTY
Other - Middle Name:J
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 268919
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8919
Mailing Address - Country:US
Mailing Address - Phone:405-608-3838
Mailing Address - Fax:405-608-3838
Practice Address - Street 1:4050 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3838
Practice Address - Fax:405-608-3838
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89488363LA2200X
COAPN.0993199-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health