Healthcare Provider Details

I. General information

NPI: 1124830088
Provider Name (Legal Business Name): HAIDY NASR APRN - CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 S NORWOOD AVE STE 110
TULSA OK
74137-5547
US

IV. Provider business mailing address

7931 S 77TH EAST AVE
TULSA OK
74133-3527
US

V. Phone/Fax

Practice location:
  • Phone: 918-943-5303
  • Fax:
Mailing address:
  • Phone: 918-720-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number215114
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number215114
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number215114
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: