Healthcare Provider Details

I. General information

NPI: 1417712738
Provider Name (Legal Business Name): LOTOYA ANTHONY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 S PEORIA AVE STE B
TULSA OK
74105-3128
US

IV. Provider business mailing address

3807 S PEORIA AVE PMB 1033 SUITE B
TULSA OK
74105-3128
US

V. Phone/Fax

Practice location:
  • Phone: 918-255-5067
  • Fax: 918-205-8631
Mailing address:
  • Phone: 918-255-5067
  • Fax: 918-205-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP207368
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number228416
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407606
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: