Healthcare Provider Details

I. General information

NPI: 1639951288
Provider Name (Legal Business Name): RALYNDA ROZELL APRN-CNP; RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N FLORENCE AVE STE 201
CLAREMORE OK
74017-3189
US

IV. Provider business mailing address

110 W 7TH ST STE 2520
TULSA OK
74119-1104
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-1886
  • Fax:
Mailing address:
  • Phone: 918-579-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number215446
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number0099399
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: