Healthcare Provider Details

I. General information

NPI: 1649787938
Provider Name (Legal Business Name): CHERALYN MAE REDDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E SKELLY DR STE 103
TULSA OK
74105-6344
US

IV. Provider business mailing address

3015 E SKELLY DR STE 103
TULSA OK
74105-6344
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-0859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number114961
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: