Healthcare Provider Details

I. General information

NPI: 1144520974
Provider Name (Legal Business Name): JODY MARIE CUMMINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 WHIRLPOOL DR
TULSA OK
74117-1305
US

IV. Provider business mailing address

6910 WHIRLPOOL DRIVE
TULSA OK
74117
US

V. Phone/Fax

Practice location:
  • Phone: 918-401-5415
  • Fax: 918-401-5416
Mailing address:
  • Phone: 918-401-5415
  • Fax: 918-401-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65310
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: