Healthcare Provider Details

I. General information

NPI: 1598460735
Provider Name (Legal Business Name): ALLISON ANN OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON ANN BAUMAN

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11610 N 137TH EAST AVE
COLLINSVILLE OK
74021-3601
US

IV. Provider business mailing address

11610 N 137TH EAST AVE
COLLINSVILLE OK
74021-3601
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-2247
  • Fax: 918-272-6185
Mailing address:
  • Phone: 918-272-2247
  • Fax: 918-272-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8536
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: