Healthcare Provider Details

I. General information

NPI: 1104762277
Provider Name (Legal Business Name): NATIVE WOUND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 36TH ST
MUSKOGEE OK
74401-5079
US

IV. Provider business mailing address

201 S 36TH ST
MUSKOGEE OK
74401-5079
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-2701
  • Fax: 539-390-3009
Mailing address:
  • Phone: 918-600-2701
  • Fax: 539-390-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA RAE THOMPSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 918-571-2499