=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568969632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A&M HEALTHCARE CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2018
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3606 N MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74106-6459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-728-8512
-----------------------------------------------------
Fax | 918-779-4127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3606 N MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74106-6459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-728-8512
-----------------------------------------------------
Fax | 918-779-4127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANITA WILLIAMS
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 918-728-8512
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 82637
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------