Healthcare Provider Details

I. General information

NPI: 1932683984
Provider Name (Legal Business Name): ASHLEY MICHELLE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL
BROKEN ARROW OK
74012-7877
US

IV. Provider business mailing address

109 W 6TH ST
OKMULGEE OK
74447-5015
US

V. Phone/Fax

Practice location:
  • Phone: 918-449-4061
  • Fax: 918-449-4075
Mailing address:
  • Phone: 918-779-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103283
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: