Healthcare Provider Details

I. General information

NPI: 1134085590
Provider Name (Legal Business Name): TARA NICHOLE BJORNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 E 38TH ST
TULSA OK
74135-5832
US

IV. Provider business mailing address

3520 E 48TH PL APT 14
TULSA OK
74135-1952
US

V. Phone/Fax

Practice location:
  • Phone: 844-458-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: