Provider Demographics
NPI:1639753841
Name:WILKINSON, TERESA (RN, OMD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:RN, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 S SHERIDAN RD STE E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4053
Mailing Address - Country:US
Mailing Address - Phone:918-261-9062
Mailing Address - Fax:
Practice Address - Street 1:6125 S SHERIDAN RD STE E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4053
Practice Address - Country:US
Practice Address - Phone:918-261-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0035669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse