Healthcare Provider Details

I. General information

NPI: 1043980386
Provider Name (Legal Business Name): ADRIANNA PETTUS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANNA FAITH ELBON DO

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 3206
OKLAHOMA CITY OK
73102-1049
US

IV. Provider business mailing address

608 NW 9TH ST STE 3206
OKLAHOMA CITY OK
73102-1049
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-3919
  • Fax:
Mailing address:
  • Phone: 918-705-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8630
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: