Healthcare Provider Details

I. General information

NPI: 1235935958
Provider Name (Legal Business Name): RICKY DENNIS APRN, FNP, AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8358
US

IV. Provider business mailing address

4050 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8358
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-3400
  • Fax:
Mailing address:
  • Phone: 405-608-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number228862
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228862
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number228862
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: