Healthcare Provider Details

I. General information

NPI: 1487837910
Provider Name (Legal Business Name): PAULA KRISTINE VINSON BSN,RNC-OB,IBCLC,RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 INTEGRIS PKWY
EDMOND OK
73034-8864
US

IV. Provider business mailing address

11541 HAMPTON DR
MIDWEST CITY OK
73130-8218
US

V. Phone/Fax

Practice location:
  • Phone: 405-657-3250
  • Fax: 405-471-0017
Mailing address:
  • Phone: 405-761-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number90483
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: