Healthcare Provider Details

I. General information

NPI: 1922100494
Provider Name (Legal Business Name): KATHERINE SUE THOMPSON FOSTER PARENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 S 124TH EAST AVE
TULSA OK
74129-8238
US

IV. Provider business mailing address

2812 S 124TH EAST AVE
TULSA OK
74129-8238
US

V. Phone/Fax

Practice location:
  • Phone: 918-437-9120
  • Fax:
Mailing address:
  • Phone: 918-437-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: