Provider Demographics
NPI:1346634474
Name:BOUCHELL, AMY NICHOL (ARNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICHOL
Last Name:BOUCHELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EVERETT DR FL 7
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:405-271-5215
Mailing Address - Fax:405-271-1236
Practice Address - Street 1:1200 EVERETT DR FL 7
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-271-5215
Practice Address - Fax:405-271-1236
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9402724363LN0000X
OK219307363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014583500Medicaid
GA003161421AMedicaid
FL014583500Medicaid