Provider Demographics
NPI:1811490691
Name:UPTOWN MEDICAL CENTER APRN-CNP, PLLC
Entity type:Organization
Organization Name:UPTOWN MEDICAL CENTER APRN-CNP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:PORSHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-474-0429
Mailing Address - Street 1:PO BOX 55691
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73155-0691
Mailing Address - Country:US
Mailing Address - Phone:405-208-4573
Mailing Address - Fax:405-429-0483
Practice Address - Street 1:1207 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3011
Practice Address - Country:US
Practice Address - Phone:405-208-4573
Practice Address - Fax:405-429-0483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPTOWN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421072363LW0102X
OK83097363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty