# PASSPORT HEALTH OF OKLAHOMA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861868259
- **Authorized official:** EMILY SUE HICKS M.S., RDN, LD (DIETITIAN)
- **Authorized official phone:** (405) 606-1086

## Contact information

- **Practice address:** 3000 UNITED FOUNDERS BLVD, SUITE 137, OKLAHOMA CITY, OK 73112-3958
- **Practice address phone:** (405) 563-8961
- **Mailing address:** 3000 UNITED FOUNDERS BLVD, SUITE 137, OKLAHOMA CITY, OK 73112-3958
- **Mailing address phone:** (405) 563-8961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | LD2080 | OK | Yes |

## Other

- **Enumeration date:** 08/19/2015
- **Last updated:** 08/19/2015