Provider Demographics
NPI:1609946102
Name:HARLEY, MICHELLE R (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:HARLEY
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7061 N SCISSORTAIL CT
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8282
Mailing Address - Country:US
Mailing Address - Phone:918-260-3939
Mailing Address - Fax:
Practice Address - Street 1:10512 N 110TH EAST AVE STE 300
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6638
Practice Address - Country:US
Practice Address - Phone:918-376-8900
Practice Address - Fax:918-376-8990
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMIL1-0432-7188363LN0000X
OKR0078629363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101110AMedicaid