Healthcare Provider Details

I. General information

NPI: 1114552312
Provider Name (Legal Business Name): EMILY HOPE ROECKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY PEARSON APRN-CNP

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N BRYANT AVE STE 200
EDMOND OK
73034-6291
US

IV. Provider business mailing address

200 N BRYANT AVE STE 200
EDMOND OK
73034-6291
US

V. Phone/Fax

Practice location:
  • Phone: 405-832-6881
  • Fax: 833-941-1685
Mailing address:
  • Phone: 405-832-6881
  • Fax: 833-941-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10022
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10022-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201597-30
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number715538
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: