Healthcare Provider Details

I. General information

NPI: 1396385431
Provider Name (Legal Business Name): YOUR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N EASTERN AVE
MOORE OK
73160-5833
US

IV. Provider business mailing address

PO BOX 892410
OKLAHOMA CITY OK
73189-2410
US

V. Phone/Fax

Practice location:
  • Phone: 405-730-6990
  • Fax:
Mailing address:
  • Phone: 405-735-9348
  • Fax: 405-730-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLEY HENTHORN
Title or Position: CREDENTIALING
Credential:
Phone: 405-237-3770