Basic Information
| Provider Information | |||||||||
| NPI: | 1003347048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENICK | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MOREY | ||||||||
| OtherFirstName: | ALYSSA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 608 NW 9TH ST STE 1100 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052313000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 608 NW 9TH ST STE 1100 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052313000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6471 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.