Individual
JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6475 S YALE AVE STE 406, TULSA, OK 74136-7818
(918) 502-9140
(918) 502-9145
Mailing address
2127 E 18TH ST, TULSA, OK 74104-5617
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0136979
OK
363LA2100X
Acute Care Nurse Practitioner
Primary
225723
OK
363LG0600X
Gerontology Nurse Practitioner
225723
OK
Other
Enumeration date
10/20/2023
Last updated
11/03/2025
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