Provider Demographics
NPI:1194551465
Name:CORY, DANIELLE B (APRN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:B
Last Name:CORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 WIRELESS WAY STE B100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2521
Mailing Address - Country:US
Mailing Address - Phone:405-246-0218
Mailing Address - Fax:405-594-6089
Practice Address - Street 1:2308B W HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-6729
Practice Address - Country:US
Practice Address - Phone:918-968-1642
Practice Address - Fax:918-987-1622
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0113405363LF0000X
OK220439363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily