Healthcare Provider Details

I. General information

NPI: 1487035770
Provider Name (Legal Business Name): JOSHUA A. MOUSHON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
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 SUITE 110
TULSA OK
74104-4000
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax: 918-582-6549
Mailing address:
  • Phone: 918-579-3826
  • Fax: 918-579-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number88008
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number88008
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: