Healthcare Provider Details

I. General information

NPI: 1114619772
Provider Name (Legal Business Name): CASEE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 S LEWIS AVE STE 100
TULSA OK
74136-1019
US

IV. Provider business mailing address

6400 S LEWIS AVE STE 100
TULSA OK
74136-1019
US

V. Phone/Fax

Practice location:
  • Phone: 918-270-4100
  • Fax:
Mailing address:
  • Phone: 918-270-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberR0131051
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number217648
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: