Healthcare Provider Details

I. General information

NPI: 1144847542
Provider Name (Legal Business Name): PREMIER HEALTHCARE, APRN-CNP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12208 SOUTH WESTERN AVENUE, SUITE B
OKLAHOMA CITY OK
73170
US

IV. Provider business mailing address

12208 S WESTERN AVE STE B
OKLAHOMA CITY OK
73170-5914
US

V. Phone/Fax

Practice location:
  • Phone: 405-201-1333
  • Fax:
Mailing address:
  • Phone: 405-735-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROY M SLOOTHEER
Title or Position: PRESIDENT
Credential:
Phone: 405-201-1333