Provider Demographics
NPI:1558969733
Name:MEADOWS, AUDRA MICHELLE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:MICHELLE
Last Name:MEADOWS
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 1:1104 HUNTING HORSE TRL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6888
Mailing Address - Country:US
Mailing Address - Phone:580-559-1644
Mailing Address - Fax:
Practice Address - Street 1:1801 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3495
Practice Address - Country:US
Practice Address - Phone:405-528-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner