Provider Demographics
NPI:1730607060
Name:SISEMORE, TABITHA JOY (RN)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:JOY
Last Name:SISEMORE
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:1717B S UTICA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5332
Mailing Address - Country:US
Mailing Address - Phone:918-744-2457
Mailing Address - Fax:918-744-2483
Practice Address - Street 1:1717B S UTICA AVE STE 205
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5332
Practice Address - Country:US
Practice Address - Phone:918-744-2457
Practice Address - Fax:918-744-2483
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK112170163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator