Healthcare Provider Details

I. General information

NPI: 1386064988
Provider Name (Legal Business Name): RANELLE MONTERRY BRACY-LEWIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S PEORIA AVE
TULSA OK
74120-3820
US

IV. Provider business mailing address

550 S PEORIA AVE
TULSA OK
74120-3820
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-1900
  • Fax: 918-382-1285
Mailing address:
  • Phone: 918-588-1900
  • Fax: 918-382-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5716
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: