Healthcare Provider Details

I. General information

NPI: 1013221084
Provider Name (Legal Business Name): TARA A MCCANTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

PO BOX 60048
OKC OK
73146-3703
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2362
  • Fax:
Mailing address:
  • Phone: 405-508-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number085427
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: