Healthcare Provider Details

I. General information

NPI: 1205769049
Provider Name (Legal Business Name): MELANIE BATTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S BOSTON AVE STE 300
TULSA OK
74103-3311
US

IV. Provider business mailing address

8613 E 86TH ST
TULSA OK
74133-4327
US

V. Phone/Fax

Practice location:
  • Phone: 918-640-9871
  • Fax:
Mailing address:
  • Phone: 918-809-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: