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General NPI Number Information
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NPI Number | 1972281574
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Entity Type | Organization
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Legal Business Name | OK PSYCH NP LLC
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 1509 NW 198TH ST
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City | EDMOND
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State | OK
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Zip | 73012-3465
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Country | US
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Telephone | 918-810-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 NW 198TH ST
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City | EDMOND
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State | OK
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Zip | 73012-3465
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | ASHLEY MATHIAS
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Credential | APRN
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Telephone | 918-810-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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