Healthcare Provider Details

I. General information

NPI: 1740970359
Provider Name (Legal Business Name): MARY CATHRYN OBRIEN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 SW 89TH ST
OKLAHOMA CITY OK
73159-6332
US

IV. Provider business mailing address

2346 ANNE LN
BLANCHARD OK
73010-7220
US

V. Phone/Fax

Practice location:
  • Phone: 405-703-3116
  • Fax: 405-757-7819
Mailing address:
  • Phone: 843-754-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212390
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: