Healthcare Provider Details

I. General information

NPI: 1346176898
Provider Name (Legal Business Name): EVAN BRYAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 4106
OKLAHOMA CITY OK
73102-1006
US

IV. Provider business mailing address

608 NW 9TH ST STE 4106
OKLAHOMA CITY OK
73102-1006
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-8367
  • Fax: 405-272-8373
Mailing address:
  • Phone: 405-272-1553
  • Fax: 405-272-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number229371
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: