Provider Demographics
NPI:1306561956
Name:RATCLIFF, HALEY ROSE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ROSE
Last Name:RATCLIFF
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 1:1919 S WHEELING AVE STE 606
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5635
Mailing Address - Country:US
Mailing Address - Phone:918-748-7878
Mailing Address - Fax:
Practice Address - Street 1:1919 S WHEELING AVE STE 606
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5635
Practice Address - Country:US
Practice Address - Phone:918-748-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4933208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics