Healthcare Provider Details

I. General information

NPI: 1124854237
Provider Name (Legal Business Name): MOLLY FOREMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 1A
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

700 NE 13TH ST # 38
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5400
  • Fax: 405-271-5696
Mailing address:
  • Phone: 405-764-8066
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10031345
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223502
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: