Healthcare Provider Details

I. General information

NPI: 1336543016
Provider Name (Legal Business Name): BETHANY BANAKOS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ROBINSON ST STE 2600
NORMAN OK
73071-6697
US

IV. Provider business mailing address

500 E ROBINSON ST STE 2600
NORMAN OK
73071-6697
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6432
  • Fax: 405-928-7513
Mailing address:
  • Phone: 405-364-6432
  • Fax: 405-928-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0404381
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: