Healthcare Provider Details

I. General information

NPI: 1487589800
Provider Name (Legal Business Name): MR. DONALD TYSON STAPLETON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 TEXOMA PL
MOORE OK
73165-7346
US

IV. Provider business mailing address

4517 TEXOMA PL
MOORE OK
73165-7346
US

V. Phone/Fax

Practice location:
  • Phone: 918-440-2025
  • Fax: 918-440-2025
Mailing address:
  • Phone: 918-440-2025
  • Fax: 918-440-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: