Healthcare Provider Details

I. General information

NPI: 1801306642
Provider Name (Legal Business Name): TRESA HENSHAW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

IV. Provider business mailing address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

V. Phone/Fax

Practice location:
  • Phone: 405-501-7700
  • Fax:
Mailing address:
  • Phone: 405-359-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number96159
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number96159
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number96159
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: