Provider Demographics
NPI:1437570876
Name:AMPLEFORD, TAYLOR OWENS (DNP-A, CRNA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:OWENS
Last Name:AMPLEFORD
Suffix:
Gender:F
Credentials:DNP-A, CRNA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LARAINE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2835 E 103RD PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5606
Mailing Address - Country:US
Mailing Address - Phone:918-728-9832
Mailing Address - Fax:
Practice Address - Street 1:4808 S 109TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5822
Practice Address - Country:US
Practice Address - Phone:918-302-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK93917367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200520980AMedicaid