Healthcare Provider Details

I. General information

NPI: 1841069077
Provider Name (Legal Business Name): ALISSA TAYLOR THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 E SKELLY DR
TULSA OK
74135-6106
US

IV. Provider business mailing address

6333 E SKELLY DR
TULSA OK
74135-6106
US

V. Phone/Fax

Practice location:
  • Phone: 539-895-9356
  • Fax:
Mailing address:
  • Phone: 918-799-7216
  • Fax: 918-633-0213

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: