Healthcare Provider Details

I. General information

NPI: 1487144580
Provider Name (Legal Business Name): MELISSA EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 E 41ST ST STE 400
TULSA OK
74146-3616
US

IV. Provider business mailing address

9702 S 78TH EAST AVE APT 9105
TULSA OK
74133-6949
US

V. Phone/Fax

Practice location:
  • Phone: 866-926-6552
  • Fax: 918-289-0551
Mailing address:
  • Phone:
  • 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: