Healthcare Provider Details

I. General information

NPI: 1275438541
Provider Name (Legal Business Name): TANESHA Y MAGNESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 W WILSHIRE BLVD STE C
OKLAHOMA CITY OK
73116-7747
US

IV. Provider business mailing address

437 W WILSHIRE BLVD STE C
OKLAHOMA CITY OK
73116-7747
US

V. Phone/Fax

Practice location:
  • Phone: 405-843-2067
  • Fax:
Mailing address:
  • Phone: 405-843-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number37V957440410
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: