Provider Demographics
NPI:1023430683
Name:HOOPER, MELANIE DENISE (APRN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENISE
Last Name:HOOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471688 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-4490
Mailing Address - Country:US
Mailing Address - Phone:918-696-8800
Mailing Address - Fax:
Practice Address - Street 1:471688 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4490
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82969363LF0000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily