MEDICARE: HAIDY NASR APRN - CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	215114	OK
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	215114	OK
3	207RI0011X	Interventional Cardiology Physician	215114	OK

General Provider Information

NPI Number	:	1124830088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAIDY NASR APRN - CNP

Provider Business Mailing Address
First Line	:	7931 S 77TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-3527
Country	:	US
Telephone Number	:	918-720-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	11912 S NORWOOD AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-5547
Country	:	US
Telephone Number	:	918-943-5303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	02/17/2025

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