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General NPI Number Information
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NPI Number | 1538777552
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Entity Type | Individual
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Provider Name | KALLIE DANIELLE GARRETT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 10505 E 91ST ST
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City | TULSA
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State | OK
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Zip | 74133-5801
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Country | US
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Telephone | 918-307-5490
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Fax | 918-779-3247
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Provider Business Mailing Address
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Address Line | 20900 S OQECHE
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City | CLAREMORE
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State | OK
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Zip | 74019-1005
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Country | US
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Telephone | 918-638-5511
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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 | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 104112
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License Number State | OK
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