Individual
DERRICK COUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8801 S 101ST EAST AVE, TULSA, OK 74133-5716
(918) 294-4915
(918) 294-4947
Mailing address
7912 E 31ST CT, STE 210, TULSA, OK 74145-1315
(918) 392-4477
(918) 392-4465
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0069640
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200052000A
—
OK
01
—
900522349
MEDICARE GROUP PIN
OK
Enumeration date
05/20/2006
Last updated
05/19/2008
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