Healthcare Provider Details

I. General information

NPI: 1205519303
Provider Name (Legal Business Name): SOUTH WIND WOMEN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 E 51ST ST
TULSA OK
74135-3512
US

IV. Provider business mailing address

PO BOX 3222
WICHITA KS
67201-3222
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-8378
  • Fax:
Mailing address:
  • Phone: 316-425-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SCHAUNTA JAMES- BOYD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-429-7940