Healthcare Provider Details

I. General information

NPI: 1447836663
Provider Name (Legal Business Name): RURAL HEALTH AND VITALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 SW 44TH ST
EL RENO OK
73036-8191
US

IV. Provider business mailing address

1621 E HWY 66 STE H
EL RENO OK
73036-5715
US

V. Phone/Fax

Practice location:
  • Phone: 405-414-4383
  • Fax:
Mailing address:
  • Phone: 405-414-4383
  • Fax: 949-561-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALANA MCKINNEY
Title or Position: OWNER
Credential: FNP-C
Phone: 405-414-4383