Healthcare Provider Details

I. General information

NPI: 1063930386
Provider Name (Legal Business Name): AMANDA LEIGH MAY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 E MELTON DR
JAY OK
74346-2704
US

IV. Provider business mailing address

58620 E 296 PL
GROVE OK
74344-8021
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-1700
  • Fax:
Mailing address:
  • Phone: 405-614-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0087012
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: