Provider Demographics
NPI:1114354727
Name:TALLON, STANLEY JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:TALLON
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1145 S UTICA AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4041
Mailing Address - Country:US
Mailing Address - Phone:918-579-5749
Mailing Address - Fax:918-579-5762
Practice Address - Street 1:1145 S UTICA AVE STE 460
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4041
Practice Address - Country:US
Practice Address - Phone:918-579-5749
Practice Address - Fax:918-579-5762
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECNP231290363LA2100X
OK79573363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care