Healthcare Provider Details

I. General information

NPI: 1801293485
Provider Name (Legal Business Name): REBECCA FAULKNER MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15804 SONADOR DR
EDMOND OK
73013-5819
US

IV. Provider business mailing address

15804 SONADOR DR
EDMOND OK
73013-5819
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6181
  • Fax: 405-601-7012
Mailing address:
  • Phone: 405-601-6181
  • Fax: 405-601-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43765
License Number StateOK

VIII. Authorized Official

Name: REBECCA FAULKNER
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 405-601-6181