Provider Demographics
NPI:1134080542
Name:PUCKETT, TIFFANY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 NW 72ND ST STE 245
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5948
Mailing Address - Country:US
Mailing Address - Phone:405-289-0483
Mailing Address - Fax:
Practice Address - Street 1:5601 NW 72ND ST STE 245
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5948
Practice Address - Country:US
Practice Address - Phone:405-289-0483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK226129363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care