Provider Demographics
NPI:1538430582
Name:NOHELTY, AMY (BS, MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NOHELTY
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HORSE SHOE LN
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5189
Mailing Address - Country:US
Mailing Address - Phone:918-429-9467
Mailing Address - Fax:
Practice Address - Street 1:210 HORSE SHOE LN
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5189
Practice Address - Country:US
Practice Address - Phone:918-429-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200305190BMedicaid