Provider Demographics
NPI:1003532300
Name:BUFFINGTON, DAWN ANNETTE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ANNETTE
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:ANNETTE
Other - Last Name:COCKRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12902 E 51ST ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-6712
Mailing Address - Country:US
Mailing Address - Phone:918-994-3476
Mailing Address - Fax:
Practice Address - Street 1:1095 N ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9641
Practice Address - Country:US
Practice Address - Phone:918-727-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0089376163W00000X
OK210689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse