Healthcare Provider Details

I. General information

NPI: 1477367357
Provider Name (Legal Business Name): MIKALA HENSLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 N MAIN ST
MIAMI OK
74354-1602
US

IV. Provider business mailing address

581 SE 3RD ST
ADAIR OK
74330-2258
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-9077
  • Fax:
Mailing address:
  • Phone: 918-530-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221802
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: