NPI 1477009256 · live from the CMS NPI Registry
Amattco LLC
Specialist in Broken Arrow, OK. National Provider Identifier 1477009256, active.
NPI record
| NPI | 1477009256 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Specialist 174400000X |
| Practice location | 3100 S Elm Pl, Suite B, Broken Arrow, OK 74012 |
| Practice phone | 918-884-7800 |
| Mailing address | 3705 West Memorial Rd, Suite 601, Oklahoma City, OK 73134 |
| Enumerated | August 31, 2016 |
| Last updated | August 31, 2016 |
| Authorized official | David Ryker, Supervising Physican |
| Other names | New Leaf Wellness Center |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Specialist | 174400000X | 9365 (OK) |
| Nurse Practitioner | 363L00000X | 79139 (OK) |
| Nurse Practitioner | 363L00000X | r0078723 (OK) |
| Nurse Practitioner | 363L00000X | 86262 (OK) |
| Specialist primary | 174400000X | 73548 (OK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.