Provider Demographics
NPI:1972104610
Name:PROGRESSING FORWARD MEDICAL AND MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PROGRESSING FORWARD MEDICAL AND MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:SHANAE
Authorized Official - Last Name:HYPOLITE-KING
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:405-439-5849
Mailing Address - Street 1:9000 NW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8677
Mailing Address - Country:US
Mailing Address - Phone:405-439-5849
Mailing Address - Fax:310-356-0781
Practice Address - Street 1:9000 NW 84TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8677
Practice Address - Country:US
Practice Address - Phone:405-439-5849
Practice Address - Fax:310-356-0781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSING FORWARD MEDICAL AND MENTAL HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-07
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty