Provider Demographics
NPI:1184243396
Name:RANCHHOD, MARY KATHERINE (APRN - CNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:RANCHHOD
Suffix:
Gender:F
Credentials:APRN - CNP
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Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8001
Practice Address - Street 1:6465 S YALE AVE STE 804
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7810
Practice Address - Country:US
Practice Address - Phone:918-502-3550
Practice Address - Fax:918-502-3555
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK113593363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201070610AMedicaid
OK13593OtherOKLAHOMA STATE BOARD OF NURSING
OK2019082057OtherANCC