Healthcare Provider Details

I. General information

NPI: 1831075399
Provider Name (Legal Business Name): OKC PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4631 N MAY AVE
OKLAHOMA CITY OK
73112-6052
US

IV. Provider business mailing address

4631 N MAY AVE
OKLAHOMA CITY OK
73112-6052
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-0004
  • Fax:
Mailing address:
  • Phone: 405-604-0004
  • Fax: 405-604-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HAYLEY DORTON
Title or Position: MEDICAL BILLER
Credential:
Phone: 405-604-0004