=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588398226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEE RACHAEL SYMCOX RN, FNTP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2022
-----------------------------------------------------
Last Update Date | 07/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16000 IRON RIDGE RD
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-5872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-826-0213
-----------------------------------------------------
Fax | 405-285-3367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7146
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73083-7146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-826-0213
-----------------------------------------------------
Fax | 405-285-3367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN1003X
-----------------------------------------------------
Taxonomy Name | Nutrition Support Registered Nurse
-----------------------------------------------------
License Number | R0096572
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------