Healthcare Provider Details

I. General information

NPI: 1801694849
Provider Name (Legal Business Name): TANYA ROYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PLAZA RM 305
MADILL OK
73446-2273
US

IV. Provider business mailing address

4700 OK HIGHWAY 78 E
MILBURN OK
73450-9616
US

V. Phone/Fax

Practice location:
  • Phone: 580-257-2002
  • Fax: 580-257-2002
Mailing address:
  • Phone: 580-565-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: