Healthcare Provider Details

I. General information

NPI: 1356828594
Provider Name (Legal Business Name): ANDREA DIANE BYFORD APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S UTICA AVE STE 300
TULSA OK
74104-4243
US

IV. Provider business mailing address

9228 S MINGO RD STE 200
TULSA OK
74133-5722
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax:
Mailing address:
  • Phone: 918-592-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number109450
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number109450
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number109450
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: