Healthcare Provider Details

I. General information

NPI: 1356892921
Provider Name (Legal Business Name): ROY SLOOTHEER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 05/30/2020
Certification Date: 05/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 RIVER BIRCH RUN
MOORE OK
73160-1378
US

IV. Provider business mailing address

1308 RIVER BIRCH RUN
MOORE OK
73160-1378
US

V. Phone/Fax

Practice location:
  • Phone: 405-201-1333
  • Fax:
Mailing address:
  • Phone: 405-201-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0116739
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: