MEDICARE: FHCOKC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144556952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FHCOKC, INC

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	PIEDMONT
State	:	OK
Zip	:	73078-0660
Country	:	US
Telephone Number	:	405-373-2400
Fax Number	:	405-373-4400

Provider Business Practice Location Address
First Line	:	6102 NW 63RD ST STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7526
Country	:	US
Telephone Number	:	405-373-2400
Fax Number	:	405-373-4400

Authorized Official
Title or Position	:	CEO
Name	:	ANTONIA M. PRATT-REID
Credential	:	APRN
Telephone Number	:	405-373-2400

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	02/25/2016

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