Healthcare Provider Details

I. General information

NPI: 1003701616
Provider Name (Legal Business Name): GWYNN L. CARUTHERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 S MINGO RD
TULSA OK
74133-5841
US

IV. Provider business mailing address

8921 S MINGO RD
TULSA OK
74133-5841
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3830
  • Fax: 918-577-4808
Mailing address:
  • Phone: 918-577-3830
  • Fax: 918-577-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number100799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: