Provider Demographics
NPI:1043728587
Name:NORMAN PSYCHIATRY APRN-CNP PLLC
Entity type:Organization
Organization Name:NORMAN PSYCHIATRY APRN-CNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-579-4111
Mailing Address - Street 1:2201 WESTPARK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4012
Mailing Address - Country:US
Mailing Address - Phone:405-579-4111
Mailing Address - Fax:405-579-4223
Practice Address - Street 1:2201 WESTPARK DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4012
Practice Address - Country:US
Practice Address - Phone:405-579-1111
Practice Address - Fax:405-579-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2020-01-13
Deactivation Date:2019-10-17
Deactivation Code:
Reactivation Date:2020-01-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200485210Medicaid
OK200768730Medicaid