Provider Demographics
NPI:1134875248
Name:RENFROW, TAMIKA DEMEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:DEMEE
Last Name:RENFROW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10818 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-2100
Mailing Address - Country:US
Mailing Address - Phone:405-414-3785
Mailing Address - Fax:
Practice Address - Street 1:901 S AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4836
Practice Address - Country:US
Practice Address - Phone:405-414-3785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0077349163WP0200X
OK207227363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics