Healthcare Provider Details

I. General information

NPI: 1932307782
Provider Name (Legal Business Name): MICHAEL RAY WOODS R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST
TULSA OK
74135-2553
US

IV. Provider business mailing address

4502 E 41ST ST
TULSA OK
74135-2553
US

V. Phone/Fax

Practice location:
  • Phone: 918-694-7973
  • Fax: 918-660-3143
Mailing address:
  • Phone: 918-694-7973
  • Fax: 918-660-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR0064849
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: