Provider Demographics
NPI:1881946259
Name:WILSON, SERENA BROOKE (ARNP)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:BROOKE
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-542-3900
Mailing Address - Fax:918-542-3928
Practice Address - Street 1:21 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6815
Practice Address - Country:US
Practice Address - Phone:918-542-3900
Practice Address - Fax:918-542-3928
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468380CMedicaid
OK200461260AMedicaid
OK200461260AMedicaid