Healthcare Provider Details

I. General information

NPI: 1609946102
Provider Name (Legal Business Name): MICHELLE R HARLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10512 N 110TH EAST AVE STE 300
OWASSO OK
74055-6638
US

IV. Provider business mailing address

7061 N SCISSORTAIL CT
OWASSO OK
74055-8282
US

V. Phone/Fax

Practice location:
  • Phone: 918-376-8900
  • Fax: 918-376-8990
Mailing address:
  • Phone: 918-260-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberMIL1-0432-7188
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR0078629
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: