Healthcare Provider Details

I. General information

NPI: 1497033740
Provider Name (Legal Business Name): ANGELA RENEA PHILLIPS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E KING AVE
SALLISAW OK
74955-5464
US

IV. Provider business mailing address

2600 E KING AVE
SALLISAW OK
74955-5464
US

V. Phone/Fax

Practice location:
  • Phone: 918-208-6480
  • Fax: 918-235-3010
Mailing address:
  • Phone: 918-208-6480
  • Fax: 918-235-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number79963
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: