Healthcare Provider Details

I. General information

NPI: 1861755456
Provider Name (Legal Business Name): ASHLEY ELIZABETH HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 NW 23RD ST STE 204
OKLAHOMA CITY OK
73107-2431
US

IV. Provider business mailing address

3133 NW 24TH ST
OKLAHOMA CITY OK
73107-1905
US

V. Phone/Fax

Practice location:
  • Phone: 405-283-1662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: