Provider Demographics
NPI:1376093443
Name:RICHEY, TIFFANY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RICHEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10712 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73151-9488
Mailing Address - Country:US
Mailing Address - Phone:405-432-6789
Mailing Address - Fax:
Practice Address - Street 1:910 NW 139TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9525
Practice Address - Country:US
Practice Address - Phone:405-254-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily