Healthcare Provider Details

I. General information

NPI: 1982205449
Provider Name (Legal Business Name): VANESSA LYNN ZICKEFOOSE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12142 S YUKON AVE
GLENPOOL OK
74033-6621
US

IV. Provider business mailing address

12142 S YUKON AVE
GLENPOOL OK
74033-6621
US

V. Phone/Fax

Practice location:
  • Phone: 918-488-8840
  • Fax: 918-488-8842
Mailing address:
  • Phone: 918-488-8840
  • Fax: 918-488-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0123057
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: