Healthcare Provider Details

I. General information

NPI: 1194798843
Provider Name (Legal Business Name): CATHEY COLBURN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 S YALE AVE STE 700
TULSA OK
74136-3310
US

IV. Provider business mailing address

4606 E 67TH ST STE 400
TULSA OK
74136-4943
US

V. Phone/Fax

Practice location:
  • Phone: 918-491-3939
  • Fax: 918-491-3960
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberR0036361
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: