Healthcare Provider Details

I. General information

NPI: 1699932228
Provider Name (Legal Business Name): OKLAHOMA CITY UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N BLACKWELDER AVE
OKLAHOMA CITY OK
73106-1402
US

IV. Provider business mailing address

2501 N BLACKWELDER AVE
OKLAHOMA CITY OK
73106-1402
US

V. Phone/Fax

Practice location:
  • Phone: 405-208-5090
  • Fax: 405-208-6016
Mailing address:
  • Phone: 405-208-5090
  • Fax: 405-208-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA JOYCE JOHNSTON
Title or Position: DIRECTOR, STUDENT HEALTH CLINIC
Credential: RN
Phone: 405-208-5090