Healthcare Provider Details

I. General information

NPI: 1881486140
Provider Name (Legal Business Name): MELISSA DIANE TEETS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 S MINGO RD
TULSA OK
74133-5841
US

IV. Provider business mailing address

14105 E 87TH TER N
OWASSO OK
74055-2572
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3699
  • Fax:
Mailing address:
  • Phone: 918-629-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR0114417
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: