Healthcare Provider Details
I. General information
NPI: 1699360586
Provider Name (Legal Business Name): ERICA MELISSA PROBST DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/03/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3336 E 32ND ST STE 102
TULSA OK
74135-4446
US
IV. Provider business mailing address
PO BOX 700054
TULSA OK
74170-0054
US
V. Phone/Fax
- Phone: 918-236-4601
- Fax:
- Phone: 918-405-8399
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 200270 |
| License Number State | OK |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: