Healthcare Provider Details

I. General information

NPI: 1174753891
Provider Name (Legal Business Name): RACHELLE LYNETTE MACKEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 10TH ST
OKLAHOMA CITY OK
73117-1207
US

IV. Provider business mailing address

1000 NE 10TH ST
OKLAHOMA CITY OK
73117-1207
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-9663
  • Fax: 405-271-1728
Mailing address:
  • Phone: 405-271-9663
  • Fax: 405-271-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR55843
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: