Healthcare Provider Details

I. General information

NPI: 1568366839
Provider Name (Legal Business Name): NOURA AL FARRA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4090
US

IV. Provider business mailing address

10562 S 93RD EAST AVE
TULSA OK
74133-6379
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone: 918-770-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3520
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: