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General NPI Number Information
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NPI Number | 1508226507
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Entity Type | Organization
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Legal Business Name | ST JOHN HEALTH SYSTEM
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1717B S UTICA AVE SUITE 205
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City | TULSA
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State | OK
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Zip | 74104-5333
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Country | US
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Telephone | 918-744-2995
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Fax |
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Provider Business Mailing Address
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Address Line | 1717B S UTICA AVE SUITE 205
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City | TULSA
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State | OK
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Zip | 74104-5333
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIABETES EDUCATOR
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Name | MS. KELLEY MICHELLE FROST
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Credential | MS RD LD CDE
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Telephone | 918-744-2449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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