MEDICARE: RICK DWIGGINS NP

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	363LG0600X	Gerontology Nurse Practitioner	R0029184	OK

General Provider Information

NPI Number	:	1235223769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK DWIGGINS NP

Provider Business Mailing Address
First Line	:	4350 WILL ROGERS PKWY
Second Line	:	SUITE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108
Country	:	US
Telephone Number	:	405-943-1144
Fax Number	:	405-943-0127

Provider Business Practice Location Address
First Line	:	2520 SOUTH RANKIN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013
Country	:	US
Telephone Number	:	405-341-1433
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/13/2021

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