Healthcare Provider Details

I. General information

NPI: 1053310375
Provider Name (Legal Business Name): DONNA CAROLE PUCKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 S YALE AVE
TULSA OK
74136-1930
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3310
US

V. Phone/Fax

Practice location:
  • Phone: 918-497-3004
  • Fax: 918-497-3247
Mailing address:
  • Phone: 918-488-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21764
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: