Healthcare Provider Details

I. General information

NPI: 1730551565
Provider Name (Legal Business Name): MELISSA LATRICE LITTLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA LATRICE LITTLE APRN-CNP

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-7403
  • Fax: 405-713-2794
Mailing address:
  • Phone: 405-713-7403
  • Fax: 405-713-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number79193
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79193
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: