Provider Demographics
NPI:1811205925
Name:PRESTON, TASHA RENEE (ARNP)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:RENEE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1810
Mailing Address - Country:US
Mailing Address - Phone:580-238-4277
Mailing Address - Fax:866-290-3285
Practice Address - Street 1:1013 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1810
Practice Address - Country:US
Practice Address - Phone:580-238-4277
Practice Address - Fax:866-290-3285
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78855363LP0808X
OKF0910335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily