Healthcare Provider Details

I. General information

NPI: 1306363833
Provider Name (Legal Business Name): WILLIAM MANSFIELD RICE III FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

616 SW 111TH ST
OKLAHOMA CITY OK
73170-5805
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4876
  • Fax:
Mailing address:
  • Phone: 405-651-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06171945
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: