Healthcare Provider Details

I. General information

NPI: 1821965120
Provider Name (Legal Business Name): TARA OKELOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 FRISCO SQUARE BLVD STE 400
FRISCO TX
75034-3251
US

IV. Provider business mailing address

1021 BRUNI CT
AUBREY TX
76227-1321
US

V. Phone/Fax

Practice location:
  • Phone: 855-903-7827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number25425781
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: