Healthcare Provider Details

I. General information

NPI: 1952596942
Provider Name (Legal Business Name): ROBYN L TILLERY B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
BARNSDALL OK
74002-6631
US

IV. Provider business mailing address

401 E MAIN ST
BARNSDALL OK
74002-6631
US

V. Phone/Fax

Practice location:
  • Phone: 918-847-3527
  • Fax:
Mailing address:
  • Phone: 918-847-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: