Healthcare Provider Details

I. General information

NPI: 1336724210
Provider Name (Legal Business Name): LAUREN MACKENZIE ADAMS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N KELLY AVE STE 200
EDMOND OK
73003-3015
US

IV. Provider business mailing address

2820 N KELLY AVE STE 200
EDMOND OK
73003-3015
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8000
  • Fax: 405-726-8101
Mailing address:
  • Phone: 405-726-8000
  • Fax: 405-726-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201480
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: