Healthcare Provider Details

I. General information

NPI: 1528641867
Provider Name (Legal Business Name): KOREY DANIELLE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 BOREN BLVD STE A
SEMINOLE OK
74868-1927
US

IV. Provider business mailing address

207 W 1ST STREET
WEWOKA OK
74884
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-5111
  • Fax: 580-436-1159
Mailing address:
  • Phone: 405-257-5422
  • Fax: 405-257-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201703
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: