Provider Demographics
NPI:1427118017
Name:NELSON, TELISHA RENE (AUD)
Entity type:Individual
Prefix:MRS
First Name:TELISHA
Middle Name:RENE
Last Name:NELSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9202 S TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2720
Mailing Address - Country:US
Mailing Address - Phone:918-493-3133
Mailing Address - Fax:918-493-2322
Practice Address - Street 1:9202 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2720
Practice Address - Country:US
Practice Address - Phone:918-493-3133
Practice Address - Fax:918-493-2322
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700078Medicare PIN