Healthcare Provider Details

I. General information

NPI: 1730214388
Provider Name (Legal Business Name): DEBRA MAE WEATHERFORD BSN, ARNP, CNSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 NE 13TH ST ORI 274
OKLAHOMA CITY OK
73117-1039
US

IV. Provider business mailing address

825 NE 10TH ST SUITE 5200
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1515
  • Fax: 405-271-1001
Mailing address:
  • Phone: 405-271-3635
  • Fax: 405-271-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR0028057
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR0028057
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: