MEDICARE: RUSSELL RYAN ROOMS ARNP

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	363L00000X	Nurse Practitioner	R0071424	OK

General Provider Information

NPI Number	:	1316982887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL RYAN ROOMS ARNP

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE STE 300
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-848-0026
Fax Number	:	800-490-9811

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 300
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-848-0026
Fax Number	:	800-490-9811

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	12/19/2023

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