Healthcare Provider Details

I. General information

NPI: 1164074472
Provider Name (Legal Business Name): TABATHA TRUELOVE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 CHANDLER RD STE 101
MUSKOGEE OK
74403-4955
US

IV. Provider business mailing address

3101 CHANDLER RD STE 101
MUSKOGEE OK
74403-4955
US

V. Phone/Fax

Practice location:
  • Phone: 918-913-7575
  • Fax: 918-913-7576
Mailing address:
  • Phone: 918-913-7575
  • Fax: 918-913-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number127850
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: