Basic Information
| Provider Information | |||||||||
| NPI: | 1306021571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOTCHER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNS, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8325 NW EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731626006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057497099 | ||||||||
| FaxNumber: | 4057739418 | ||||||||
| Practice Location | |||||||||
| Address1: | 8325 NW EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731626006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057497099 | ||||||||
| FaxNumber: | 4057739418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 79164 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SE0003X | 73164 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Emergency |
ID Information
| ID | Type | State | Issuer | Description | 79164 | 01 | OK | STATE LICENSE | OTHER |