Healthcare Provider Details

I. General information

NPI: 1962372185
Provider Name (Legal Business Name): OWEN GEBERTH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5864 E 146TH ST S
BIXBY OK
74008-8071
US

IV. Provider business mailing address

5864 E 146TH ST S
BIXBY OK
74008-8071
US

V. Phone/Fax

Practice location:
  • Phone: 539-664-0313
  • Fax:
Mailing address:
  • Phone: 539-664-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0127702
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: