Healthcare Provider Details

I. General information

NPI: 1508660135
Provider Name (Legal Business Name): ALEXA RAE RAWLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

18817 GROVE PKWY
EDMOND OK
73012-4499
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-7000
  • Fax:
Mailing address:
  • Phone: 208-724-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9730
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: