Healthcare Provider Details

I. General information

NPI: 1386421527
Provider Name (Legal Business Name): CHRIS N. M. MUMFORD APRN-CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 S DETROIT AVE
TULSA OK
74105-3039
US

IV. Provider business mailing address

3903 S DETROIT AVE
TULSA OK
74105-3039
US

V. Phone/Fax

Practice location:
  • Phone: 405-627-5133
  • Fax:
Mailing address:
  • Phone: 405-627-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number214516
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number214516
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: