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General NPI Number Information
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NPI Number | 1487157772
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Entity Type | Individual
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Provider Name | MISTI JAYNE MOON-HARRIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 8125 S WALKER AVE STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9417
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Country | US
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Telephone | 405-619-4479
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Fax |
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Provider Business Mailing Address
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Address Line | 2948 NW 33RD ST
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City | NEWCASTLE
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State | OK
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Zip | 73065-6580
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Country | US
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Telephone | 405-410-3905
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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 | 73220
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License Number State | OK
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