Healthcare Provider Details

I. General information

NPI: 1013726991
Provider Name (Legal Business Name): REESEY RUSSELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 S UTICA AVE
TULSA OK
74136-3907
US

IV. Provider business mailing address

7010 S UTICA AVE
TULSA OK
74136-3907
US

V. Phone/Fax

Practice location:
  • Phone: 940-704-1700
  • Fax: 918-890-4133
Mailing address:
  • Phone: 940-704-1700
  • Fax: 918-890-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220773
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: