Healthcare Provider Details

I. General information

NPI: 1578247243
Provider Name (Legal Business Name): CHECOTAH BRIT PARDUE RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 26
LEHIGH OK
74556-0026
US

IV. Provider business mailing address

PO BOX 26
LEHIGH OK
74556-0026
US

V. Phone/Fax

Practice location:
  • Phone: 405-901-0062
  • Fax:
Mailing address:
  • Phone: 405-901-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number211367
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: