Healthcare Provider Details

I. General information

NPI: 1245232255
Provider Name (Legal Business Name): TAMARA JO GRABEAL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/17/2024
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N WASHINGTON ST
WEATHERFORD OK
73096-2443
US

IV. Provider business mailing address

701 CEDAR LAKE BLVD STE 120
OKLAHOMA CITY OK
73114-7815
US

V. Phone/Fax

Practice location:
  • Phone: 580-772-2820
  • Fax: 580-772-2845
Mailing address:
  • Phone: 405-445-1210
  • Fax: 580-203-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0059923
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: