Healthcare Provider Details

I. General information

NPI: 1083954416
Provider Name (Legal Business Name): TARA ELIZABETH BYROM APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 41ST ST
TULSA OK
74135-2527
US

IV. Provider business mailing address

11911 S OAK ST
JENKS OK
74037-2667
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4400
  • Fax: 918-619-4334
Mailing address:
  • Phone: 918-851-2425
  • Fax: 918-619-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP847716
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201401241NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2013042963
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number75260
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: