Provider Demographics
NPI:1831911304
Name:EDSON, BARRY NICHOLAS
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:NICHOLAS
Last Name:EDSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:BARRY
Other - Last Name:EDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7416 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-5106
Mailing Address - Country:US
Mailing Address - Phone:405-657-9682
Mailing Address - Fax:
Practice Address - Street 1:4300 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5107
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist