Healthcare Provider Details

I. General information

NPI: 1972281574
Provider Name (Legal Business Name): OK PSYCH NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 NW 198TH ST
EDMOND OK
73012-3465
US

IV. Provider business mailing address

616 GROVE CREST RD
PRYOR OK
74361-8413
US

V. Phone/Fax

Practice location:
  • Phone: 918-810-9118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MATHIAS
Title or Position: PMHNP
Credential: APRN
Phone: 918-810-9118