Individual
TIERRA PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1330 N CLASSEN BLVD STE 116, OKLAHOMA CITY, OK 73106-6834
(405) 209-2083
Mailing address
9325 EMILY LN, MIDWEST CITY, OK 73130-4330
(405) 209-2083
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
88907
OK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R0088907
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88907
OBN
OK
Enumeration date
03/17/2016
Last updated
09/13/2024
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