Healthcare Provider Details

I. General information

NPI: 1811800030
Provider Name (Legal Business Name): PHATASIA CORTESS NEIGHBORS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 NW 164TH ST
EDMOND OK
73013-8801
US

IV. Provider business mailing address

2220 NW 164TH ST
EDMOND OK
73013-8801
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-6961
  • Fax:
Mailing address:
  • Phone: 405-757-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: