Provider Demographics
NPI:1740715630
Name:MISTY DEAN, INC
Entity type:Organization
Organization Name:MISTY DEAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:405-410-5675
Mailing Address - Street 1:4401 SE 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-8138
Mailing Address - Country:US
Mailing Address - Phone:405-410-5675
Mailing Address - Fax:405-429-7522
Practice Address - Street 1:4401 SE 37TH ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-8138
Practice Address - Country:US
Practice Address - Phone:405-410-5675
Practice Address - Fax:405-429-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty