Healthcare Provider Details

I. General information

NPI: 1265150346
Provider Name (Legal Business Name): ALISON C TUTTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 13TH ST STE 205
GROVE OK
74344-2981
US

IV. Provider business mailing address

1111 W 17TH ST
TULSA OK
74107-1886
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-2243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5424
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: