Healthcare Provider Details

I. General information

NPI: 1144030354
Provider Name (Legal Business Name): SYDNEY OWEN RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

1602 AVENUE Q
LUBBOCK TX
79401-4732
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number24OK1215
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: