Healthcare Provider Details

I. General information

NPI: 1407390115
Provider Name (Legal Business Name): EMPOWER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9659 RIVERSIDE PKWY
TULSA OK
74137-7398
US

IV. Provider business mailing address

9659 RIVERSIDE PKWY
TULSA OK
74137-7398
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-5040
  • Fax: 918-299-9041
Mailing address:
  • Phone: 918-299-5040
  • Fax: 918-299-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20296
License Number StateOK

VIII. Authorized Official

Name: JENNIFER C. WOLF
Title or Position: MD/PHYSICIAN
Credential: M.D.
Phone: 918-299-5040