Healthcare Provider Details

I. General information

NPI: 1811490691
Provider Name (Legal Business Name): UPTOWN MEDICAL CENTER APRN-CNP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 S SUNNYLANE RD
DEL CITY OK
73115-3011
US

IV. Provider business mailing address

PO BOX 55691
DEL CITY OK
73155-0691
US

V. Phone/Fax

Practice location:
  • Phone: 405-208-4573
  • Fax: 405-429-0483
Mailing address:
  • Phone: 405-208-4573
  • Fax: 405-429-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number83097
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421072
License Number StateNY

VIII. Authorized Official

Name: MS. PORSHA LYNN RICHARDSON
Title or Position: MEMBER
Credential: NP
Phone: 405-474-0429