Healthcare Provider Details

I. General information

NPI: 1902737471
Provider Name (Legal Business Name): ANGELA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372138 E 1030 RD
OKEMAH OK
74859-5940
US

IV. Provider business mailing address

420 NE 21ST ST
NEWCASTLE OK
73065-6129
US

V. Phone/Fax

Practice location:
  • Phone: 405-479-3421
  • Fax: 405-479-3421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: