Healthcare Provider Details

I. General information

NPI: 1780184978
Provider Name (Legal Business Name): JEFFREY KINSLEY RICE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
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
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-497-3004
  • Fax: 918-497-3005
Mailing address:
  • Phone: 918-488-6687
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6736
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: