Provider Demographics
NPI:1104278548
Name:HENRICHS, ALLISON DIANE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DIANE
Last Name:HENRICHS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1501 S RANCHWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2758
Mailing Address - Country:US
Mailing Address - Phone:405-914-6634
Mailing Address - Fax:405-914-6693
Practice Address - Street 1:1501 S RANCHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2758
Practice Address - Country:US
Practice Address - Phone:405-914-6634
Practice Address - Fax:405-914-6693
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK73681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily