Provider Demographics
NPI:1023006343
Name:SUMMERLIN, NATALIE ARLENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ARLENE
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5631
Mailing Address - Country:US
Mailing Address - Phone:918-748-7600
Mailing Address - Fax:918-403-6316
Practice Address - Street 1:1919 S WHEELING AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5631
Practice Address - Country:US
Practice Address - Phone:918-748-7600
Practice Address - Fax:918-403-6316
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0065326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1791386Medicaid
OKP18985Medicare UPIN