Healthcare Provider Details

I. General information

NPI: 1437492436
Provider Name (Legal Business Name): MELISA WEAVER APRN - CNP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD SUITE 200
EDMOND OK
73013-3023
US

IV. Provider business mailing address

1800 RENAISSANCE BLVD SUITE 200
EDMOND OK
73013-3023
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-2473
  • Fax: 405-341-2495
Mailing address:
  • Phone: 405-359-3475
  • Fax: 405-341-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71855
License Number StateOK

VIII. Authorized Official

Name: MS. MELISA D. WEAVER
Title or Position: OWNER / NURSE PRACTITIONER
Credential: APRN-CNP
Phone: 405-359-3475