Healthcare Provider Details

I. General information

NPI: 1154962546
Provider Name (Legal Business Name): ELIZABETH ANN POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

IV. Provider business mailing address

510 E MEMORIAL RD
OKLAHOMA CITY OK
73114-2229
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-5370
  • Fax:
Mailing address:
  • Phone: 405-777-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101342
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: