Provider Demographics
NPI:1407127202
Name:CROSS, MIKEL ANN
Entity Type:Individual
Prefix:
First Name:MIKEL
Middle Name:ANN
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKEL
Other - Middle Name:ANN
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3209 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4131
Mailing Address - Country:US
Mailing Address - Phone:405-842-3209
Mailing Address - Fax:
Practice Address - Street 1:3209 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4131
Practice Address - Country:US
Practice Address - Phone:405-842-3209
Practice Address - Fax:405-628-6898
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0086611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200432670AMedicaid
OK299709YMU8Medicare PIN