Healthcare Provider Details

I. General information

NPI: 1841056900
Provider Name (Legal Business Name): MS. TONYA RENEE' SUBLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

IV. Provider business mailing address

414 NW 57TH ST
LAWTON OK
73505-5715
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-8620
  • Fax:
Mailing address:
  • Phone: 580-917-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number220017
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: