Healthcare Provider Details

I. General information

NPI: 1104418151
Provider Name (Legal Business Name): CARE PATHWAYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 5TH ST STE 206
ENID OK
73701-5861
US

IV. Provider business mailing address

2910 ADAMS RD STE 110
NORMAN OK
73069-1023
US

V. Phone/Fax

Practice location:
  • Phone: 405-928-2727
  • Fax: 405-928-2720
Mailing address:
  • Phone: 405-928-2727
  • Fax: 405-928-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KELLY
Title or Position: MANAGER OF LLC
Credential:
Phone: 405-928-2727