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General NPI Number Information
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NPI Number | 1598353534
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Entity Type | Organization
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Legal Business Name | NOVASTAR FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 5046 N PEORIA AVE STE 100
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City | TULSA
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State | OK
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Zip | 74126-3446
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Country | US
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Telephone | 539-424-5943
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Fax | 539-424-5946
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Provider Business Mailing Address
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Address Line | 5046 N PEORIA AVE STE 100
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City | TULSA
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State | OK
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Zip | 74126-3446
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Country | US
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Telephone | 539-424-5943
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Fax | 539-424-5946
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Authorized Official
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Title or Position | OWNER/EMPLOYEE
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Name | MRS. NATALIE RENAYE JONES
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Credential | NURSE PRACTITIONER
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Telephone | 539-424-5943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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