Healthcare Provider Details

I. General information

NPI: 1770415135
Provider Name (Legal Business Name): JA'LISA MURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N 26TH WEST AVE
TULSA OK
74127-5137
US

IV. Provider business mailing address

617 N 26TH WEST AVE
TULSA OK
74127-5137
US

V. Phone/Fax

Practice location:
  • Phone: 918-809-9166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: