MEDICARE: COMPOSURE SOLUTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1053137034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPOSURE SOLUTION LLC

Provider Business Mailing Address
First Line	:	9001 W 51ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-8547
Country	:	US
Telephone Number	:	918-815-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 W 41ST ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-2752
Country	:	US
Telephone Number	:	918-816-9443
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	STEPHANIE ANN DURHAM
Credential	:	NP
Telephone Number	:	918-815-9443

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	04/08/2026

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Directions to “COMPOSURE SOLUTION LLC ” Practice Location

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