Healthcare Provider Details

I. General information

NPI: 1114930229
Provider Name (Legal Business Name): MARY CATHRYN MERIDETH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHRYN SULLIVAN MERIDETH ARNP

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 W I 35 FRONTAGE RD
EDMOND OK
73013-8504
US

IV. Provider business mailing address

530 N MONTE VISTA SUITE A
ADA OK
74820-4675
US

V. Phone/Fax

Practice location:
  • Phone: 405-509-2800
  • Fax: 405-509-2885
Mailing address:
  • Phone: 580-436-7101
  • Fax: 580-436-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0077161
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: