Healthcare Provider Details

I. General information

NPI: 1801703467
Provider Name (Legal Business Name): APPELLO ADVANCED PRIMARY CARE OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ROGERS AVE
FORT SMITH AR
72901-1903
US

IV. Provider business mailing address

415 ROGERS AVE
FORT SMITH AR
72901-1903
US

V. Phone/Fax

Practice location:
  • Phone: 479-783-4672
  • Fax:
Mailing address:
  • Phone: 479-783-4672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON LEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-650-8348