Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95106 | OK |
NPI | 1003248659 |
---|---|
Provider Name | Mrs. Rachel Leigh Cross |
First Address | Oklahoma City, OK 73104-4637 |
Second Address | Oklahoma City, OK 73104-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 06/08/2013 |