Healthcare Provider Details

I. General information

NPI: 1194448985
Provider Name (Legal Business Name): TASHA ROSE WHITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W BRITTON RD APT 78
OKLAHOMA CITY OK
73120-2045
US

IV. Provider business mailing address

3200 W BRITTON RD APT 78
OKLAHOMA CITY OK
73120-2045
US

V. Phone/Fax

Practice location:
  • Phone: 580-484-5491
  • Fax:
Mailing address:
  • Phone: 580-484-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: