Healthcare Provider Details

I. General information

NPI: 1487622858
Provider Name (Legal Business Name): LEANNA M HARKESS CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD SUITE 408
OKLAHOMA CITY OK
73120-8366
US

IV. Provider business mailing address

4140 W MEMORIAL RD SUITE 408
OKLAHOMA CITY OK
73120-8366
US

V. Phone/Fax

Practice location:
  • Phone: 405-486-8670
  • Fax: 405-486-8671
Mailing address:
  • Phone: 405-486-8670
  • Fax: 405-486-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number62
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: