Healthcare Provider Details

I. General information

NPI: 1679915458
Provider Name (Legal Business Name): REBECCA NICHOLE MOORE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 S MINGO RD
TULSA OK
74133-5710
US

IV. Provider business mailing address

9320 S MINGO RD
TULSA OK
74133-5710
US

V. Phone/Fax

Practice location:
  • Phone: 918-879-1700
  • Fax: 918-879-1701
Mailing address:
  • Phone: 918-879-1700
  • Fax: 918-879-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number92306
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: