Individual ProviderAmy BloughNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address11601 S Western Ave, Oklahoma City, OK 73170-5823(405) 622-2070PECOS EnrollmentBased on the most recent information from CMS, provider Amy Blough is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:58 AM.Profile DetailsProvider ID1548663669Provider TypeIndividualFull NameBlough, AmyCredentialFNPGenderFemaleSole ProprietorNoEnumeration Date10/2/2014Last Updated6/16/2016Contact InformationPractice LocationPractice Address11601 S Western Ave, Oklahoma City, OK 73170-5823Phone(405) 622-2070FaxUnlisted FaxMailing LocationMailing Address1007 N Country Club Rd, Ada, OK 74820-2847Phone(405) 622-2070FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense96085Oklahoma