MEDICARE: REBECCA CLINE

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	63489	OK

General Provider Information

NPI Number	:	1366720229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CLINE

Provider Business Mailing Address
First Line	:	10512 N 110TH EAST AVE
Second Line	:	#100
City	:	OWASSO
State	:	OK
Zip	:	74055-6636
Country	:	US
Telephone Number	:	918-272-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	7302 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7027
Country	:	US
Telephone Number	:	918-712-4301
Fax Number	:	855-855-4102

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	06/18/2019

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Directions to “ REBECCA CLINE ” Practice Location

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