Healthcare Provider Details

I. General information

NPI: 1124969449
Provider Name (Legal Business Name): DANIEL JUDSON PHILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N BROWN ST
SAPULPA OK
74066-3231
US

IV. Provider business mailing address

2540 E 7TH ST APT 7
TULSA OK
74104-3353
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-9072
  • Fax:
Mailing address:
  • Phone: 918-978-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1606388
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: