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General NPI Number Information
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NPI Number | 1457852659
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Entity Type | Organization
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Legal Business Name | MINDFUL PSYCHIATRY, PC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 5014 E 101ST ST STE 200
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City | TULSA
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State | OK
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Zip | 74137-5803
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Country | US
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Telephone | 918-701-3770
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Fax | 918-701-3779
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Provider Business Mailing Address
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Address Line | 2831 E 103RD PL
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City | TULSA
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State | OK
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Zip | 74137-5606
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Country | US
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Telephone | 918-701-3770
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Fax | 918-701-3779
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREA OLIVER SKELTON
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Credential | MD
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Telephone | 918-701-3770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 29707
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License Number State | OK
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