Healthcare Provider Details

I. General information

NPI: 1740072883
Provider Name (Legal Business Name): PAIGE PENDRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 S MINGO RD
TULSA OK
74133-5841
US

IV. Provider business mailing address

3814 E 83RD ST
TULSA OK
74137-1705
US

V. Phone/Fax

Practice location:
  • Phone: 918-252-8000
  • Fax:
Mailing address:
  • Phone: 918-978-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR0131785
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: