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General NPI Number Information
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NPI Number | 1841967221
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Entity Type | Individual
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Provider Name | MRS. HALEY ANN WATERS
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1265 S UTICA AVE STE 300
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City | TULSA
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State | OK
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Zip | 74104-4243
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Country | US
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Telephone | 918-592-0999
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Fax | 918-592-1021
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Provider Business Mailing Address
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Address Line | 1145 S UTICA AVE STE 110
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City | TULSA
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State | OK
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Zip | 74104-4013
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Country | US
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Telephone | 918-579-2981
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Fax | 918-579-1262
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4944
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License Number State | OK
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