Healthcare Provider Details

I. General information

NPI: 1679754014
Provider Name (Legal Business Name): KATHY ROSSMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE STE. 200
TULSA OK
74133-5726
US

IV. Provider business mailing address

8803 S 101ST EAST AVE STE. 200
TULSA OK
74133-5726
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-2273
  • Fax: 918-307-0273
Mailing address:
  • Phone: 918-307-2273
  • Fax: 918-307-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR0064497
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: