Healthcare Provider Details

I. General information

NPI: 1518735216
Provider Name (Legal Business Name): MOHINI KANTUBHAI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E DOWNING ST STE 101
TAHLEQUAH OK
74464-3354
US

IV. Provider business mailing address

701 HOLIDAY DR
TAHLEQUAH OK
74464-5185
US

V. Phone/Fax

Practice location:
  • Phone: 806-678-5028
  • Fax:
Mailing address:
  • Phone: 806-678-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number230073
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: