Healthcare Provider Details

I. General information

NPI: 1760314959
Provider Name (Legal Business Name): TARA DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SUGAR CREEK DR
HINTON OK
73047-9512
US

IV. Provider business mailing address

700 SUGAR CREEK DR
HINTON OK
73047-9512
US

V. Phone/Fax

Practice location:
  • Phone: 405-542-3711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210671
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: