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General NPI Number Information
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NPI Number | 1154208999
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Entity Type | Individual
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Provider Name | JOAN NYASULU PERISHO APRN
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Gender | Female
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 6565 S YALE AVE STE 312
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City | TULSA
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State | OK
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Zip | 74136-8304
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Country | US
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Telephone | 918-502-1900
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Fax | 918-494-6303
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Provider Business Mailing Address
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Address Line | 21888 S 4126 RD
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City | CLAREMORE
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State | OK
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Zip | 74019-3814
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Country | US
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Telephone | 918-313-5284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 225342
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License Number State | OK
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