Healthcare Provider Details

I. General information

NPI: 1245932425
Provider Name (Legal Business Name): AMY ELWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELWELL WATSON, GERHART

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 N NESBITT AVE APT E
OKLAHOMA CITY OK
73112-3382
US

IV. Provider business mailing address

3511 N NESBITT AVE APT E
OKLAHOMA CITY OK
73112-3382
US

V. Phone/Fax

Practice location:
  • Phone: 813-838-0045
  • Fax:
Mailing address:
  • Phone: 813-838-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: