Healthcare Provider Details

I. General information

NPI: 1598683138
Provider Name (Legal Business Name): TIFFANY RICHARDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 E 140TH ST S
BIXBY OK
74008-4895
US

IV. Provider business mailing address

2118 E 140TH ST S
BIXBY OK
74008-4895
US

V. Phone/Fax

Practice location:
  • Phone: 918-457-8490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR0109978
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: