Provider Demographics
NPI:1548970437
Name:OBI, CHRISTOLOGUS O (APRN-CNP, PMHNP)
Entity type:Individual
Prefix:
First Name:CHRISTOLOGUS
Middle Name:O
Last Name:OBI
Suffix:
Gender:M
Credentials:APRN-CNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2353
Mailing Address - Country:US
Mailing Address - Phone:580-226-0543
Mailing Address - Fax:580-226-2284
Practice Address - Street 1:1104 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2353
Practice Address - Country:US
Practice Address - Phone:580-226-0543
Practice Address - Fax:580-226-2284
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098897363LP0808X
OK213780363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201217830AMedicaid
OK213780OtherOKLAHOMA STATE BOARD OF NURSING