Healthcare Provider Details

I. General information

NPI: 1669384749
Provider Name (Legal Business Name): ATTAIRA ANGELIQUE PRINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S HOUSTON AVE
TULSA OK
74127-9043
US

IV. Provider business mailing address

8805 NW 120TH ST
OKLAHOMA CITY OK
73162-1142
US

V. Phone/Fax

Practice location:
  • Phone: 918-921-3200
  • Fax:
Mailing address:
  • Phone: 405-837-0115
  • 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: