Provider Demographics
NPI:1639951288
Name:ROZELL, RALYNDA (APRN-CNP; RN)
Entity type:Individual
Prefix:
First Name:RALYNDA
Middle Name:
Last Name:ROZELL
Suffix:
Gender:F
Credentials:APRN-CNP; RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 E 430 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6890
Mailing Address - Country:US
Mailing Address - Phone:918-906-8153
Mailing Address - Fax:
Practice Address - Street 1:220 W 71ST ST STE 2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2011
Practice Address - Country:US
Practice Address - Phone:918-584-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215446363LP2300X
OK0099399163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis