Healthcare Provider Details

I. General information

NPI: 1932573490
Provider Name (Legal Business Name): LELA CUPP APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 3RD ST
ELK CITY OK
73644-5145
US

IV. Provider business mailing address

PO BOX 2339
ELK CITY OK
73648-2339
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-2511
  • Fax:
Mailing address:
  • Phone: 580-821-5320
  • Fax: 580-225-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number99035
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: