Provider Demographics
NPI:1477907244
Name:THOMAS, RUBY V (APRN,CNP)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:V
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN,CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 E 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5242
Mailing Address - Country:US
Mailing Address - Phone:918-935-3240
Mailing Address - Fax:918-935-3241
Practice Address - Street 1:2811 E 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5242
Practice Address - Country:US
Practice Address - Phone:918-935-3240
Practice Address - Fax:918-935-3241
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK75370OtherSTATE LICENSE