Provider Demographics
NPI:1205235363
Name:ARNETT, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2615
Mailing Address - Country:US
Mailing Address - Phone:918-574-0350
Mailing Address - Fax:918-574-0359
Practice Address - Street 1:10512 N 110TH EAST AVE STE 300
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6638
Practice Address - Country:US
Practice Address - Phone:918-376-8900
Practice Address - Fax:918-574-0359
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80761363LF0000X
OK0080761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200569780AMedicaid
OK200569780AMedicaid