Healthcare Provider Details

I. General information

NPI: 1043186083
Provider Name (Legal Business Name): AMY FARRAR COHLMIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6161 S YALE AVE
TULSA OK
74136-1902
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-6150
  • Fax:
Mailing address:
  • Phone: 918-502-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number226001
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number226001
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: