Healthcare Provider Details

I. General information

NPI: 1932052016
Provider Name (Legal Business Name): LEAH CLARE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E 79TH ST
TULSA OK
74133-4682
US

IV. Provider business mailing address

481 W 149TH ST S
GLENPOOL OK
74033-4366
US

V. Phone/Fax

Practice location:
  • Phone: 918-233-9550
  • Fax:
Mailing address:
  • Phone: 918-361-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number211360
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: