Healthcare Provider Details

I. General information

NPI: 1922779594
Provider Name (Legal Business Name): NATRUWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 GLENMANOR DR
MIDWEST CITY OK
73110-1212
US

IV. Provider business mailing address

912 GLENMANOR DR
MIDWEST CITY OK
73110-1212
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-9355
  • Fax: 888-298-0174
Mailing address:
  • Phone: 405-470-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAKERA JACKSON
Title or Position: OWNER
Credential: LPC
Phone: 405-470-9355