Healthcare Provider Details

I. General information

NPI: 1154236271
Provider Name (Legal Business Name): COURTNEY G. WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 E 87TH ST
TULSA OK
74137-2628
US

IV. Provider business mailing address

3417 E 87TH ST
TULSA OK
74137-2628
US

V. Phone/Fax

Practice location:
  • Phone: 216-744-3586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: