Provider Demographics
NPI:1215928700
Name:LEDET, TINA (ARNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LEDET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE SOUTH BRYANT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034
Mailing Address - Country:US
Mailing Address - Phone:405-359-5561
Mailing Address - Fax:405-359-5215
Practice Address - Street 1:ONE SOUTH BRYANT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-359-5561
Practice Address - Fax:405-359-5215
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR48985363L00000X
OKR0048985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP96268Medicare UPIN