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General NPI Number Information
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NPI Number | 1831075399
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Entity Type | Organization
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Legal Business Name | OKC PRIMARY CARE
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 4631 N MAY AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-6052
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Country | US
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Telephone | 405-604-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 4631 N MAY AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-6052
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Country | US
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Telephone | 405-604-0004
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Fax | 405-604-0235
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | HAYLEY DORTON
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Credential |
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Telephone | 405-604-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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