Healthcare Provider Details

I. General information

NPI: 1396600508
Provider Name (Legal Business Name): ALEX NICOLE YARGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 SW 30TH CT STE B
MOORE OK
73160-2887
US

IV. Provider business mailing address

1113 SW 30TH CT STE B
MOORE OK
73160-2887
US

V. Phone/Fax

Practice location:
  • Phone: 405-676-8470
  • Fax:
Mailing address:
  • Phone: 405-676-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number211872
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: