Healthcare Provider Details

I. General information

NPI: 1922964907
Provider Name (Legal Business Name): TIFFANY DAWN POWELL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 E OAK ST
CUSHING OK
74023-3644
US

IV. Provider business mailing address

1442 E OAK ST
CUSHING OK
74023-3644
US

V. Phone/Fax

Practice location:
  • Phone: 918-221-0896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226785
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: