Healthcare Provider Details

I. General information

NPI: 1750262408
Provider Name (Legal Business Name): CORNERSTONE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E 141ST ST
GLENPOOL OK
74033-3583
US

IV. Provider business mailing address

PO BOX 103
KIEFER OK
74041-0103
US

V. Phone/Fax

Practice location:
  • Phone: 918-771-8771
  • Fax: 918-553-0356
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY SOMMER
Title or Position: OWNER
Credential: APRN, CPNP-PC
Phone: 918-519-7315