Provider Demographics
NPI:1700989316
Name:DEAN, MISTY DAWN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:DEAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3366 NW EXPRESSWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4416
Mailing Address - Country:US
Mailing Address - Phone:405-702-1300
Mailing Address - Fax:405-702-1280
Practice Address - Street 1:3366 NW EXPRESSWAY STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4416
Practice Address - Country:US
Practice Address - Phone:405-702-1300
Practice Address - Fax:405-702-1280
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067385363LA2200X
OK67385363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34697Medicare UPIN