MEDICARE: NANCY ANN OWENS AGPCNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	99953	OK

General Provider Information

NPI Number	:	1194283424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN OWENS AGPCNP-BC

Provider Business Mailing Address
First Line	:	5101 SW 120TH CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-8875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 SW 120TH CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-8875
Country	:	US
Telephone Number	:	405-802-9102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	03/05/2019

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