Healthcare Provider Details

I. General information

NPI: 1366352718
Provider Name (Legal Business Name): TAYLOR MARIE GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 S JAMESTOWN AVE
TULSA OK
74135
US

IV. Provider business mailing address

9305 W 160TH ST N
SKIATOOK OK
74070-6209
US

V. Phone/Fax

Practice location:
  • Phone: 918-978-0090
  • Fax:
Mailing address:
  • Phone: 918-978-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number155261
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: