Healthcare Provider Details

I. General information

NPI: 1063341873
Provider Name (Legal Business Name): GINA FORD APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S COUNTRY CLUB RD
EL RENO OK
73036-5427
US

IV. Provider business mailing address

1900 S COUNTRY CLUB RD
EL RENO OK
73036-5427
US

V. Phone/Fax

Practice location:
  • Phone: 405-295-2900
  • Fax: 405-295-2425
Mailing address:
  • Phone: 405-295-2900
  • Fax: 405-295-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228461
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: