NPI 1386505709 · live from the CMS NPI Registry
Age Erase Medical Aesthetics
Nurse Practitioner in Tulsa, OK. National Provider Identifier 1386505709, active.
NPI record
| NPI | 1386505709 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner 363L00000X |
| Practice location | 7010 S Utica Ave, Tulsa, OK 74136 |
| Practice phone | 940-704-1700 |
| Enumerated | November 24, 2025 |
| Last updated | March 4, 2026 |
| Authorized official | Reesey Russell, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinic/Center, Primary Care | 261QP2300X | — |
| Nurse Practitioner primary | 363L00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.