Provider Demographics
NPI:1316614498
Name:RUSSELL-TYLER, BRITNEI ALYS
Entity type:Individual
Prefix:
First Name:BRITNEI
Middle Name:ALYS
Last Name:RUSSELL-TYLER
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 1:7126 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8159
Mailing Address - Country:US
Mailing Address - Phone:404-857-2747
Mailing Address - Fax:
Practice Address - Street 1:7126 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-8159
Practice Address - Country:US
Practice Address - Phone:404-857-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RP1900X, 374J00000X
OK175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No374J00000XNursing Service Related ProvidersDoula