Healthcare Provider Details

I. General information

NPI: 1023415841
Provider Name (Legal Business Name): SUZANNE KIRBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S UTICA AVE STE 1105
TULSA OK
74104
US

IV. Provider business mailing address

3450 E FRANK PHILLIPS BLVD STE 200
BARTLESVILLE OK
74006-2401
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5749
  • Fax:
Mailing address:
  • Phone: 918-331-2445
  • Fax: 918-331-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number83127
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: