Provider Demographics
NPI:1154908689
Name:TULLIS, CHRISTY L (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:TULLIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 W HEFNER RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6927
Mailing Address - Country:US
Mailing Address - Phone:405-286-9533
Mailing Address - Fax:405-607-0927
Practice Address - Street 1:948 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6927
Practice Address - Country:US
Practice Address - Phone:405-286-9533
Practice Address - Fax:405-607-0927
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0043635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse