Healthcare Provider Details

I. General information

NPI: 1831599653
Provider Name (Legal Business Name): AMY PEARCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W MAIN ST STE 205
NORMAN OK
73069-6851
US

IV. Provider business mailing address

1225 W MAIN ST STE 205
NORMAN OK
73069-6851
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-5500
  • Fax: 405-292-5505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0098049
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: