Basic Information
Provider Information
NPI: 1346627304
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITE
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6600 S YALE AVE STE 1200
Address2:  
City: TULSA
State: OK
PostalCode: 741363361
CountryCode: US
TelephoneNumber: 9184886045
FaxNumber: 9184886098
Practice Location
Address1: 140 W 151ST ST S STE 202
Address2:  
City: GLENPOOL
State: OK
PostalCode: 74033
CountryCode: US
TelephoneNumber: 9183217400
FaxNumber: 9183217415
Other Information
ProviderEnumerationDate: 04/29/2015
LastUpdateDate: 02/21/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X6071OKY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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