Healthcare Provider Details

I. General information

NPI: 1982341848
Provider Name (Legal Business Name): GEANY CHANG APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E BROADWAY CT STE A
SAND SPRINGS OK
74063-7931
US

IV. Provider business mailing address

401 E BROADWAY CT STE A
SAND SPRINGS OK
74063-7931
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-6008
  • Fax:
Mailing address:
  • Phone: 918-794-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG02220079
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: