Basic Information
| Provider Information | |||||||||
| NPI: | 1992174304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UAP OF OKLAHOMA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15305 DALLAS PKWY | ||||||||
| Address2: | 1600 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750014637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727133547 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8100 S WALKER AVE | ||||||||
| Address2: | BLDG C | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731399402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056026500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2015 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | HARPER | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | ANESTHESIA PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9727133547 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.