Healthcare Provider Details

I. General information

NPI: 1972497832
Provider Name (Legal Business Name): CLARIS MBELEKA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

512 N FRANKLIN ST STE 100
JENKS OK
74037-2490
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3131
  • Fax:
Mailing address:
  • Phone: 800-683-5919
  • Fax: 833-627-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number223406
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: