Healthcare Provider Details

I. General information

NPI: 1386577971
Provider Name (Legal Business Name): MARISSA JONAGAN BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA NICOLE JONAGAN

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 8TH ST
TULSA OK
74119-1404
US

IV. Provider business mailing address

1712 W 120TH ST S
JENKS OK
74037-2978
US

V. Phone/Fax

Practice location:
  • Phone: 918-832-7763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: