Healthcare Provider Details

I. General information

NPI: 1548789688
Provider Name (Legal Business Name): TARA ANN HENDERSON APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12038 N MAY AVE
OKLAHOMA CITY OK
73120-6807
US

IV. Provider business mailing address

12038 N MAY AVE
OKLAHOMA CITY OK
73120-6807
US

V. Phone/Fax

Practice location:
  • Phone: 405-724-5437
  • Fax: 405-724-6917
Mailing address:
  • Phone: 405-724-5437
  • Fax: 405-724-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123087
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: