Healthcare Provider Details

I. General information

NPI: 1164353249
Provider Name (Legal Business Name): RURAL OKLAHOMA BIRTH & WELLNESS INITIATIVE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 6TH ST
CLAREMORE OK
74017-6005
US

IV. Provider business mailing address

307 W 6TH ST
CLAREMORE OK
74017-6005
US

V. Phone/Fax

Practice location:
  • Phone: 918-510-5468
  • Fax:
Mailing address:
  • Phone: 918-510-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: SHANNON MARIE FAIR
Title or Position: DIRECTOR
Credential: FAIR
Phone: 918-510-5468