Healthcare Provider Details

I. General information

NPI: 1144069949
Provider Name (Legal Business Name): HOLLY D HAZARD APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY D HARE

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W BROADWAY ST
OKEMAH OK
74859-2618
US

IV. Provider business mailing address

209 W BROADWAY ST
OKEMAH OK
74859-2618
US

V. Phone/Fax

Practice location:
  • Phone: 800-640-9741
  • Fax: 918-967-3351
Mailing address:
  • Phone: 800-640-9741
  • Fax: 918-967-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220118
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1158948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: