Healthcare Provider Details

I. General information

NPI: 1023770203
Provider Name (Legal Business Name): ALEXIS LAYNE HUFFAKER CMAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 MOHAWK BLVD
TULSA OK
74110-1519
US

IV. Provider business mailing address

2442 MOHAWK BLVD
TULSA OK
74110-1519
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-9800
  • Fax: 918-430-1995
Mailing address:
  • Phone: 918-280-9800
  • Fax: 918-430-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: