Healthcare Provider Details

I. General information

NPI: 1649822545
Provider Name (Legal Business Name): JOHN MICAH H POWERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S ELM ST STE 200
JENKS OK
74037-3701
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-403-7144
  • Fax: 918-856-5561
Mailing address:
  • Phone: 918-403-7144
  • Fax: 918-856-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7027
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: