Healthcare Provider Details

I. General information

NPI: 1164123451
Provider Name (Legal Business Name): ALI CHAUDAHRY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

IV. Provider business mailing address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number211984
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: