Healthcare Provider Details

I. General information

NPI: 1265100978
Provider Name (Legal Business Name): LINH KHANH THUY SRAMEK APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 SE 7TH CIR
MOORE OK
73160-6716
US

IV. Provider business mailing address

13700 S WESTERN AVE STE 100
OKLAHOMA CITY OK
73170-7006
US

V. Phone/Fax

Practice location:
  • Phone: 405-201-2669
  • Fax:
Mailing address:
  • Phone: 405-806-7246
  • Fax: 405-703-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number205279
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0106628
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: