Healthcare Provider Details

I. General information

NPI: 1558804880
Provider Name (Legal Business Name): PATRICIA WITMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S UTICA AVE STE 460
TULSA OK
74104-4041
US

IV. Provider business mailing address

1145 S UTICA AVE STE 460
TULSA OK
74104-4041
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5749
  • Fax: 918-579-5762
Mailing address:
  • Phone: 918-579-5749
  • Fax: 918-579-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number109928
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: