Healthcare Provider Details

I. General information

NPI: 1922910710
Provider Name (Legal Business Name): GEORGETTE(918) 504-3727 E. MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13508 S OAK ST
GLENPOOL OK
74033-3226
US

IV. Provider business mailing address

13508 S OAK ST
GLENPOOL OK
74033-3226
US

V. Phone/Fax

Practice location:
  • Phone: 918-504-3727
  • Fax:
Mailing address:
  • Phone: 918-504-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: