Healthcare Provider Details

I. General information

NPI: 1962975458
Provider Name (Legal Business Name): JERRIE DE'NIECE MORALES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 S YALE AVE
TULSA OK
74136-1930
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-495-2685
  • Fax: 918-495-2660
Mailing address:
  • Phone: 918-488-6687
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number84859
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: