Healthcare Provider Details

I. General information

NPI: 1316575913
Provider Name (Legal Business Name): HALLIE GURULE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALLIE FREDERICK DO

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARSON ST
JONESBORO AR
72401-3104
US

IV. Provider business mailing address

1111 W 17TH ST
TULSA OK
74107-1886
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7297
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-20963
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: