Healthcare Provider Details

I. General information

NPI: 1265166318
Provider Name (Legal Business Name): CHRISTINA DIANE OVERLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 E 48TH ST
TULSA OK
74146-5830
US

IV. Provider business mailing address

10901 E 48TH ST
TULSA OK
74146-5830
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-8765
  • Fax: 918-392-2155
Mailing address:
  • Phone: 918-749-8765
  • Fax: 918-392-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number208893
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: