Provider Demographics
NPI:1386421527
Name:MUMFORD, CHRIS N M (APRN-CNS)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:N M
Last Name:MUMFORD
Suffix:
Gender:M
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3039
Mailing Address - Country:US
Mailing Address - Phone:405-627-5133
Mailing Address - Fax:
Practice Address - Street 1:3903 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3039
Practice Address - Country:US
Practice Address - Phone:405-627-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK214516364SG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology