Healthcare Provider Details

I. General information

NPI: 1053126680
Provider Name (Legal Business Name): EMILY SERENA RICHERT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 NW 122ND ST
OKLAHOMA CITY OK
73120-8869
US

IV. Provider business mailing address

13100 COLONYPOINTE BLVD STE 103
PIEDMONT OK
73078-8828
US

V. Phone/Fax

Practice location:
  • Phone: 405-463-3380
  • Fax:
Mailing address:
  • Phone: 405-596-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222124
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR0133121
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: