Healthcare Provider Details

I. General information

NPI: 1285359547
Provider Name (Legal Business Name): MICHELLE N EVANS APRN-CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE STE 200
TULSA OK
74133-5730
US

IV. Provider business mailing address

8803 S 101ST EAST AVE STE 200
TULSA OK
74133-5730
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-2273
  • Fax:
Mailing address:
  • Phone: 191-830-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR0089370
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: