Healthcare Provider Details

I. General information

NPI: 1750170445
Provider Name (Legal Business Name): PERI YOUNT CPED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 S YALE AVE STE 909
TULSA OK
74136-8310
US

IV. Provider business mailing address

6565 S YALE AVE STE 909
TULSA OK
74136-8310
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-5975
  • Fax: 918-502-5980
Mailing address:
  • Phone: 918-502-5975
  • Fax: 918-502-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED4867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: