Provider Demographics
NPI:1689120289
Name:OKLAHOMA ADVANCED PRACTICE FAMILY NURSING, PLLC
Entity Type:Organization
Organization Name:OKLAHOMA ADVANCED PRACTICE FAMILY NURSING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-821-7008
Mailing Address - Street 1:4200 SOUTH DOUGLAS AVENUE, SUITE 225
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109
Mailing Address - Country:US
Mailing Address - Phone:405-821-7008
Mailing Address - Fax:405-635-1013
Practice Address - Street 1:4200 S DOUGLAS AVE STE 225
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3224
Practice Address - Country:US
Practice Address - Phone:405-821-7008
Practice Address - Fax:405-635-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0058331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1174975023OtherNPPES