Healthcare Provider Details

I. General information

NPI: 1639744949
Provider Name (Legal Business Name): CLAIRE NICOLE FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date: 10/05/2022
Reactivation Date: 10/18/2022

III. Provider practice location address

5310 E 31ST ST LOWR LEVEL
TULSA OK
74135-5018
US

IV. Provider business mailing address

101 N GREENWOOD AVE STE 131
TULSA OK
74120
US

V. Phone/Fax

Practice location:
  • Phone: 918-348-5052
  • Fax:
Mailing address:
  • Phone: 918-599-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: