Provider Demographics
NPI:1225230907
Name:ROYSTER, TINA M (BA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 W GARY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7523
Mailing Address - Country:US
Mailing Address - Phone:918-455-3462
Mailing Address - Fax:
Practice Address - Street 1:7010 S YALE AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5702
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:918-495-0779
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator