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General NPI Number Information
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NPI Number | 1891826368
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Entity Type | Organization
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Legal Business Name | TULSA PEDIATRIC GROUP, PC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 6465 S YALE AVE STE 715
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City | TULSA
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State | OK
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Zip | 74136-7809
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Country | US
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Telephone | 918-481-4750
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Fax | 918-481-4755
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Provider Business Mailing Address
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Address Line | 6465 S YALE AVE STE 715
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City | TULSA
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State | OK
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Zip | 74136-7809
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Country | US
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Telephone | 918-481-4750
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Fax | 918-481-4755
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN M STEVENS
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Credential | M.D.
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Telephone | 918-481-4750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9951
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License Number State | OK
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