Healthcare Provider Details

I. General information

NPI: 1275088635
Provider Name (Legal Business Name): SAMANTHA TUCKER APRN-CNS, ACGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA KUPLICKI

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 S GARNETT RD STE C
TULSA OK
74146-5222
US

IV. Provider business mailing address

4750 S GARNETT RD STE C
TULSA OK
74146-5222
US

V. Phone/Fax

Practice location:
  • Phone: 539-812-2106
  • Fax: 800-243-8301
Mailing address:
  • Phone: 539-812-2106
  • Fax: 800-243-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberR0101047
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number101047
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number0101047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: