MEDICARE: KAMI PASCUCCI

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	R0113596	OK

General Provider Information

NPI Number	:	1730764275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMI PASCUCCI

Provider Business Mailing Address
First Line	:	4345 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1702
Country	:	US
Telephone Number	:	405-752-3528
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 MEMORIAL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5004
Country	:	US
Telephone Number	:	405-749-7099
Fax Number	:

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

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	05/07/2021

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Directions to “ KAMI PASCUCCI ” Practice Location

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