Vivian Tadlock
Individual provider Active NPI Case Management Registered Nurse · Prague, OK
NPI 1659901874 · NPPES record last updated Jan 16, 2020
Key facts
- NPI
- 1659901874
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Management Registered Nurse 163WC0400X
- License
- 50524 (OK)
- Practice address
- 57533 Moccasin Trail Rd
Prague, OK 74864-1143 - Phone
- (405) 567-0054
- NPI assigned
- Jan 16, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50524 | OK | MD | Case Management Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 50524 | OK | Yes |
Addresses
Primary practice location
57533 Moccasin Trail Rd
Prague, OK 74864-1143
Mailing address
57533 Moccasin Trail Rd
Prague, OK 74864-1143
Phone (405) 567-0054
Other providers in Prague, OK
- Francis M Shelton
- Simpsons Prague Pharmacy PLLC
- Nickolas Lee Sitter
- Kyle Spears
- Cora Spencer
- Demetria Lavonna Tryon
- United Emergency Medical Service LLC
- Wal-Mart Stores East LP
- Mary Ann Ward
- Waypoint Mental Health Counseling, LLC
All providers in Prague, OK · Case Management Registered Nurse in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.