Provider Demographics
NPI:1831075399
Name:OKC PRIMARY CARE
Entity type:Organization
Organization Name:OKC PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-604-0004
Mailing Address - Street 1:4631 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6052
Mailing Address - Country:US
Mailing Address - Phone:405-604-0004
Mailing Address - Fax:405-604-0235
Practice Address - Street 1:4631 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6052
Practice Address - Country:US
Practice Address - Phone:405-604-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200980380AMedicaid