Provider Demographics
NPI:1215706932
Name:TUGMON, CHELSI LEEANN
Entity type:Individual
Prefix:
First Name:CHELSI
Middle Name:LEEANN
Last Name:TUGMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSI
Other - Middle Name:LEEANN
Other - Last Name:MUSTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15626 S 4402
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-5298
Mailing Address - Country:US
Mailing Address - Phone:918-803-1953
Mailing Address - Fax:
Practice Address - Street 1:1728 S CARSON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4610
Practice Address - Country:US
Practice Address - Phone:918-406-3420
Practice Address - Fax:918-280-0310
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist