Healthcare Provider Details

I. General information

NPI: 1124654959
Provider Name (Legal Business Name): MS. TIARA SHACOLE CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 N HARTFORD AVE
TULSA OK
74106-3550
US

IV. Provider business mailing address

36 E CAMERON ST # 19
TULSA OK
74103-1405
US

V. Phone/Fax

Practice location:
  • Phone: 918-829-3942
  • Fax:
Mailing address:
  • Phone: 918-829-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: