Healthcare Provider Details

I. General information

NPI: 1225906431
Provider Name (Legal Business Name): AUBREY G RODDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 S MINGO RD
TULSA OK
74133-5718
US

IV. Provider business mailing address

9228 S MINGO RD
TULSA OK
74133-5718
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax:
Mailing address:
  • Phone: 918-574-9735
  • Fax: 918-595-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: