1699098822 NPI number — ABIGAIL JANE DAVIS ARNP

Table of content: ABIGAIL JANE DAVIS ARNP (NPI 1699098822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699098822 NPI number — ABIGAIL JANE DAVIS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
ABIGAIL
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINBURN
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699098822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268838
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126-8838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-619-4100
Provider Business Mailing Address Fax Number:
918-619-4152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4444 E 41ST ST FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-619-4400
Provider Business Practice Location Address Fax Number:
918-619-4152
Provider Enumeration Date:
03/02/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  98165 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)