Individual
TINA RENAE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
1000 ROLLING HILLS LN, ADA, OK 74820-9415
(580) 436-3600
Mailing address
PO BOX 11, SULPHUR, OK 73086-0011
(580) 399-1452
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
214202
OK
Other
Enumeration date
07/14/2023
Last updated
07/14/2023
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