Healthcare Provider Details

I. General information

NPI: 1174195960
Provider Name (Legal Business Name): ASHLEY NICOLE GARVEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE LITTON

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CROSSROADS BLVD STE 100
NORMAN OK
73072-3359
US

IV. Provider business mailing address

2624 LAKESIDE DR
THE VILLAGE OK
73120-3309
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-2715
  • Fax:
Mailing address:
  • Phone: 405-996-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0122077
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: