Healthcare Provider Details

I. General information

NPI: 1669305371
Provider Name (Legal Business Name): ROOTED HEALTH PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E KENOSHA ST
BROKEN ARROW OK
74012-2012
US

IV. Provider business mailing address

1409 E KENOSHA ST
BROKEN ARROW OK
74012-2012
US

V. Phone/Fax

Practice location:
  • Phone: 918-262-4515
  • Fax: 949-883-7221
Mailing address:
  • Phone:
  • 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: ERIN ASHLEY
Title or Position: OWNER
Credential: PA-C
Phone: 918-520-4742