Individual
VICKY LYNN WEIDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 TURTLE DR, WYANDOTTE, OK 74370-2114
(918) 678-2282
(918) 678-3136
Mailing address
11933 S ERIE AVE, TULSA, OK 74137-8433
(918) 261-1225
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
113030
MT
207P00000X
Emergency Medicine Physician
12846203-1205
UT
207P00000X
Emergency Medicine Physician
Primary
15349
OK
207P00000X
Emergency Medicine Physician
M-16685
ID
208D00000X
General Practice Physician
15349
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100135210A
—
OK
01
—
930016273
RR MEDICARE
OK
01
—
P00159520
RR MEDICARE
OK
Enumeration date
04/27/2006
Last updated
12/10/2025
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