=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467891572
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAKE CARE HEALTH OKLAHOMA, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2013
-----------------------------------------------------
Last Update Date | 01/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1099 GARTH BROOKS BLVD
-----------------------------------------------------
City | YUKON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73099-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-825-3227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 E VOORHEES ST MS 640
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61834-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-825-3227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICIAL
-----------------------------------------------------
Name | JENNIFER PHIPPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-825-3227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------