Provider Demographics
NPI:1578309357
Name:EMERSON, ANNIE
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 UNITED FOUNDERS BLVD STE 239
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4294
Mailing Address - Country:US
Mailing Address - Phone:405-840-7040
Mailing Address - Fax:
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD STE 239
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4294
Practice Address - Country:US
Practice Address - Phone:405-840-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty