Healthcare Provider Details

I. General information

NPI: 1063279909
Provider Name (Legal Business Name): RACHEL MICHELLE MOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 08/06/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

3808 WOODSHADOW RD
EDMOND OK
73003-3046
US

V. Phone/Fax

Practice location:
  • Phone: 55-499-6904
  • Fax:
Mailing address:
  • Phone: 405-401-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR0128713
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number219745
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: