MEDICARE: RICKY DENNIS APRN

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	163WE0003X	Emergency Registered Nurse	R0131651	OK
2	363LF0000X	Family Nurse Practitioner	228862	OK

General Provider Information

NPI Number	:	1235935958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY DENNIS APRN

Provider Business Mailing Address
First Line	:	4050 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8358
Country	:	US
Telephone Number	:	405-608-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8382
Country	:	US
Telephone Number	:	405-608-3800
Fax Number	:

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

Provider Enumeration Date	:	02/22/2025
Last Update Date	:	05/22/2026

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Directions to “ RICKY DENNIS APRN” Practice Location

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