Provider Demographics
NPI:1740842053
Name:FEUERBORN, MICHEAL SCOTT (APRN)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:SCOTT
Last Name:FEUERBORN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:580-290-6424
Mailing Address - Fax:580-290-6423
Practice Address - Street 1:1021 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-4661
Practice Address - Country:US
Practice Address - Phone:580-290-6424
Practice Address - Fax:580-290-6423
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0092023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty