Healthcare Provider Details

I. General information

NPI: 1245249416
Provider Name (Legal Business Name): FELICIA BRUMMETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 S YALE AVE STE 1200
TULSA OK
74136-8313
US

IV. Provider business mailing address

6565 S YALE AVE STE 1200
TULSA OK
74136-8313
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9433
  • Fax:
Mailing address:
  • Phone: 918-494-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0055381
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: