Healthcare Provider Details

I. General information

NPI: 1225245194
Provider Name (Legal Business Name): AMY DANIELLE HULSEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY DANIELLE KLUGE CNS

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 NW 39TH EXPRESSWAY
BETHANY OK
73008
US

IV. Provider business mailing address

6800 NW 39TH EXPRESSWAY
BETHANY OK
73008
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-6711
  • Fax: 405-349-5145
Mailing address:
  • Phone: 405-789-6711
  • Fax: 405-789-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number66211
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number0066211
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: