Healthcare Provider Details

I. General information

NPI: 1043095268
Provider Name (Legal Business Name): ALICIA ORTIZ DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD STE 203
LAWTON OK
73505-6350
US

IV. Provider business mailing address

3201 W GORE BLVD
LAWTON OK
73505-6378
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6540
  • Fax: 580-354-5937
Mailing address:
  • Phone: 580-250-6540
  • Fax: 580-354-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0136309
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219040
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: