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General NPI Number Information
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NPI Number | 1295197713
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Entity Type | Individual
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Provider Name | ALICE ROY
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Gender | Female
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 2412 SW 96TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-6864
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Country | US
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Telephone | 918-813-6484
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 SW 96TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-6864
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Country | US
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Telephone | 918-813-6484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F1115586
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License Number State | OK
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