Healthcare Provider Details

I. General information

NPI: 1982978722
Provider Name (Legal Business Name): LAVEDA LYNN ROBERTS APRN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 19TH ST STE 303
EDMOND OK
73013-6618
US

IV. Provider business mailing address

1501 E 19TH ST STE 303
EDMOND OK
73013-6618
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-6511
  • Fax: 405-471-6522
Mailing address:
  • Phone: 405-471-6511
  • Fax: 405-471-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number755622
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberM0070626
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: