Healthcare Provider Details

I. General information

NPI: 1073408530
Provider Name (Legal Business Name): ALECIA DIANE MCCARTHY 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

1924 S UTICA AVE STE 400
TULSA OK
74104-6510
US

IV. Provider business mailing address

1409 E RENO ST
BROKEN ARROW OK
74012-9380
US

V. Phone/Fax

Practice location:
  • Phone: 918-973-4796
  • Fax:
Mailing address:
  • Phone: 918-453-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR0078191
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: