Healthcare Provider Details

I. General information

NPI: 1891869574
Provider Name (Legal Business Name): KATHY SITTLER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE SUITE 507
TULSA OK
74136-7823
US

IV. Provider business mailing address

6465 S YALE AVE SUITE 507
TULSA OK
74136-7823
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-2760
  • Fax: 918-481-2775
Mailing address:
  • Phone: 918-481-2760
  • Fax: 918-481-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number21481
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: