Provider Demographics
NPI:1609340132
Name:BROGDON, MOLLY MEGAN (APRN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MEGAN
Last Name:BROGDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:918-488-6045
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6465 S YALE AVE STE 420
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7806
Practice Address - Country:US
Practice Address - Phone:918-502-1700
Practice Address - Fax:918-502-1715
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK105865363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care