Healthcare Provider Details

I. General information

NPI: 1710500681
Provider Name (Legal Business Name): AMY L MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1200
US

IV. Provider business mailing address

619 NW 23RD ST STE 100
OKLAHOMA CITY OK
73103-1415
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2428
  • Fax:
Mailing address:
  • Phone: 405-528-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number73103
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: