Individual
TY FULLINGIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(918) 561-8324
Mailing address
2224 AVIAN WAY, OKLAHOMA CITY, OK 73170-3416
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/12/2025
Last updated
05/12/2025
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