Healthcare Provider Details

I. General information

NPI: 1477680122
Provider Name (Legal Business Name): LINDA KAY ROUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 E SHAWNEE RD
MUSKOGEE OK
74403-1530
US

IV. Provider business mailing address

7525 BORDER AVE
MUSKOGEE OK
74401-8527
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR0080012
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: