Healthcare Provider Details

I. General information

NPI: 1467921353
Provider Name (Legal Business Name): ERIKA ELAINE FAULK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE
TULSA OK
74114-3300
US

IV. Provider business mailing address

11818 S 84TH EAST AVE
BIXBY OK
74008-1914
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-4301
  • Fax: 918-560-1399
Mailing address:
  • Phone: 918-798-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: