Healthcare Provider Details

I. General information

NPI: 1386253680
Provider Name (Legal Business Name): ABBY CAROLINE HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 S YALE AVE STE B
TULSA OK
74135-6002
US

IV. Provider business mailing address

2718 E 93RD ST APT 222
TULSA OK
74137-4607
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-7300
  • Fax:
Mailing address:
  • Phone: 512-968-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: