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1104522697 NPI number — ANGIE OSBORN PMHNP-BC

NPI Number: 1104522697
Health Care Provider/Practitioner: ANGIE OSBORN PMHNP-BC

Information about “1104522697” NPI (ANGIE OSBORN PMHNP-BC) exists in 1104522697 in HTML format HTML  |  1104522697 in plain Text format TXT  |  1104522697 in PDF (Portable Document Format) PDF  |  1104522697 in an XML format XML  formats.

NPI Number : 1104522697 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104522697",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OSBORN",
    "FirstName": "ANGIE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PMHNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1501 S RANCHWOOD BLVD STE 203",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YUKON",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73099-2758",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "405-914-6634",
    "MailingAddressFaxNumber": "405-914-6693",
    "FirstLinePracticeLocationAddress": "1501 S RANCHWOOD BLVD STE 203",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YUKON",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73099-2758",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "405-914-6634",
    "PracticeLocationAddressFaxNumber": "405-914-6693",
    "EnumerationDate": "02/06/2023",
    "LastUpdateDate": "02/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "11/19/2024",
    "NPIReactivationDate": "11/25/2024",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "211056",
        "LicenseNumberStateCode": "OK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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