Healthcare Provider Details

I. General information

NPI: 1427994334
Provider Name (Legal Business Name): EBENEZERTELEHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7415 NW 23RD ST
BETHANY OK
73008-5135
US

IV. Provider business mailing address

5625 NW 130TH ST
OKLAHOMA CITY OK
73142-6085
US

V. Phone/Fax

Practice location:
  • Phone: 405-349-8188
  • Fax:
Mailing address:
  • Phone: 405-501-6154
  • Fax: 718-640-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUSAN GEORGE
Title or Position: OWNER
Credential:
Phone: 405-501-6154