Healthcare Provider Details

I. General information

NPI: 1134207616
Provider Name (Legal Business Name): OLIVIA GENE YORK NEONATAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA GENE SMITH

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE STE 2123
TULSA OK
74104
US

IV. Provider business mailing address

1120 S UTICA AVE STE 2123
TULSA OK
74104-4012
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5402
  • Fax: 918-579-5404
Mailing address:
  • Phone: 918-579-5402
  • Fax: 918-579-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number72422
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR0072422
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: