Provider Demographics
NPI:1174602270
Name:WHITESIDE, THERESIA VILYNE (ARNP)
Entity type:Individual
Prefix:MS
First Name:THERESIA
Middle Name:VILYNE
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:THERESIA
Other - Middle Name:VILYNE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:315 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-2203
Mailing Address - Country:US
Mailing Address - Phone:918-582-9355
Mailing Address - Fax:918-594-4889
Practice Address - Street 1:315 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-2203
Practice Address - Country:US
Practice Address - Phone:918-582-9355
Practice Address - Fax:918-594-4889
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0027126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner