Healthcare Provider Details

I. General information

NPI: 1376406850
Provider Name (Legal Business Name): BLUEPRINT SIGNATURE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W DELMAR ST.
BROKEN ARROW OK
74012
US

IV. Provider business mailing address

3171 S 129TH EAST AVE STE A-2082
TULSA OK
74134-3205
US

V. Phone/Fax

Practice location:
  • Phone: 855-395-0763
  • Fax: 918-895-0969
Mailing address:
  • Phone: 855-395-0763
  • Fax: 918-895-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHAKEIA LASHAE GILL
Title or Position: OWNER
Credential:
Phone: 918-841-2359