Healthcare Provider Details

I. General information

NPI: 1083329411
Provider Name (Legal Business Name): ASHLEY KULA-IMTIAZ IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E CAMPBELL ST STE 215
EDMOND OK
73034-4660
US

IV. Provider business mailing address

217 E CAMPBELL ST STE 215
EDMOND OK
73034-4660
US

V. Phone/Fax

Practice location:
  • Phone: 405-326-9618
  • Fax: 405-896-9377
Mailing address:
  • Phone: 405-326-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-309216
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: