Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 96474 | OK |
NPI | 1003362658 |
---|---|
Provider Name | Brandi Dickey |
First Address | Edmond, OK 73012 |
Second Address | Oklahoma City, OK 73104-5417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 30/09/2016 |