Healthcare Provider Details

I. General information

NPI: 1518641836
Provider Name (Legal Business Name): VITALITY HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

IV. Provider business mailing address

1118 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

V. Phone/Fax

Practice location:
  • Phone: 918-912-7040
  • Fax: 918-912-7045
Mailing address:
  • Phone: 918-912-7040
  • Fax: 918-912-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA S BRISCOE
Title or Position: MANAGER
Credential:
Phone: 918-808-7626