Provider Demographics
NPI:1114899333
Name:BLUE, DERRICKA WARNISHA
Entity type:Individual
Prefix:
First Name:DERRICKA
Middle Name:WARNISHA
Last Name:BLUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 N HARTFORD AVE APT D
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-3511
Mailing Address - Country:US
Mailing Address - Phone:539-430-8484
Mailing Address - Fax:
Practice Address - Street 1:2187 N HARTFORD AVE APT D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-3511
Practice Address - Country:US
Practice Address - Phone:539-430-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula