Healthcare Provider Details

I. General information

NPI: 1841130960
Provider Name (Legal Business Name): CALEB A MULKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4262 S 109TH EAST AVE APT 1317
TULSA OK
74146-3942
US

IV. Provider business mailing address

4262 S 109TH EAST AVE APT 1317
TULSA OK
74146-3942
US

V. Phone/Fax

Practice location:
  • Phone: 806-999-1870
  • Fax:
Mailing address:
  • Phone: 806-999-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-1536-1148040
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: