Individual
LOGAN REVILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 494-2200
Mailing address
23003 E 104TH ST S, BROKEN ARROW, OK 74014-6256
(918) 760-6709
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
227095
OK
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
R0133810
OK
Other
Enumeration date
11/03/2025
Last updated
03/19/2026
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