Healthcare Provider Details

I. General information

NPI: 1255245510
Provider Name (Legal Business Name): TWELVESTONE INFUSION CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S GATEWAY PL # 101A
JENKS OK
74037-3448
US

IV. Provider business mailing address

PO BOX 12369
MURFREESBORO TN
37129-0048
US

V. Phone/Fax

Practice location:
  • Phone: 844-893-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TARA HARRELSON
Title or Position: DIRECTOR
Credential:
Phone: 615-278-3278