Healthcare Provider Details

I. General information

NPI: 1992674030
Provider Name (Legal Business Name): KARLA DAWN WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17225 MIDWEST BLVD
NORMAN OK
73026-7905
US

IV. Provider business mailing address

17225 MIDWEST BLVD
NORMAN OK
73026-7905
US

V. Phone/Fax

Practice location:
  • Phone: 405-850-8081
  • Fax:
Mailing address:
  • Phone: 405-850-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR0111774
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: