Healthcare Provider Details

I. General information

NPI: 1932452000
Provider Name (Legal Business Name): SEPIDEH AHMADPOUR APNP-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 N MERIDIAN AVE
OKLAHOMA CITY OK
73116-1423
US

IV. Provider business mailing address

PO BOX 7223
EDMOND OK
73083-7223
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-8450
  • Fax:
Mailing address:
  • Phone: 214-275-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number721833
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: