Healthcare Provider Details

I. General information

NPI: 1245095439
Provider Name (Legal Business Name): NATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S BRYANT AVE
EDMOND OK
73034-5742
US

IV. Provider business mailing address

910 S BRYANT AVE
EDMOND OK
73034-5742
US

V. Phone/Fax

Practice location:
  • Phone: 405-833-4890
  • Fax:
Mailing address:
  • Phone: 405-216-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAUREN WALTERS
Title or Position: NURSE PRACTITIONER
Credential: APRN-CNP
Phone: 405-216-3510