Healthcare Provider Details

I. General information

NPI: 1154554459
Provider Name (Legal Business Name): AMI NICHOLE HESS RPA (CBRPA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SOUTH GARNETT RD SUITE 300
TULSA OK
74146
US

IV. Provider business mailing address

4500 SOUTH GARNETT RD
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-4491
  • Fax: 918-635-3231
Mailing address:
  • Phone: 918-599-4491
  • Fax: 918-635-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number09 AR 1382
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: