Healthcare Provider Details

I. General information

NPI: 1619599958
Provider Name (Legal Business Name): JONATHAN LURZ MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 N SIOUX AVE
CLAREMORE OK
74017-3700
US

IV. Provider business mailing address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-2622
  • Fax: 918-342-2641
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR0096298
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: