MEDICARE: MALACHI NATHANIEL MARTIN FNP

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	F02180469	OK

General Provider Information

NPI Number	:	1487154761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALACHI NATHANIEL MARTIN FNP

Provider Business Mailing Address
First Line	:	1122 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8920 NW 103RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6017
Country	:	US
Telephone Number	:	580-216-1146
Fax Number	:

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

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	03/03/2026

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