Healthcare Provider Details

I. General information

NPI: 1215442728
Provider Name (Legal Business Name): REBECCA KAY EDWARDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

1145 S UTICA AVE STE 110
TULSA OK
74104-4013
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax: 918-579-1218
Mailing address:
  • Phone: 918-579-1000
  • Fax: 918-382-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number78873
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: