Provider Demographics
NPI:1487423216
Name:RAJU, BECKY ANNIE (FNP-C)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:ANNIE
Last Name:RAJU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3384
Mailing Address - Country:US
Mailing Address - Phone:405-371-9438
Mailing Address - Fax:
Practice Address - Street 1:213 AMANDA DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3384
Practice Address - Country:US
Practice Address - Phone:405-371-9438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0131971163WX0200X
OK216010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology