Healthcare Provider Details

I. General information

NPI: 1982248100
Provider Name (Legal Business Name): REBEKAH JOY PRESLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 N ASPEN AVE
BROKEN ARROW OK
74012-1197
US

IV. Provider business mailing address

10714 E 122ND ST N
COLLINSVILLE OK
74021-5557
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-6008
  • Fax: 918-615-6548
Mailing address:
  • Phone: 918-277-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98182
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: