Healthcare Provider Details

I. General information

NPI: 1164181244
Provider Name (Legal Business Name): ACHIEVE HEALTH FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6922 S WESTERN AVE
OKLAHOMA CITY OK
73139-1803
US

IV. Provider business mailing address

6922 S WESTERN AVE
OKLAHOMA CITY OK
73139-1803
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-0483
  • Fax: 405-561-6856
Mailing address:
  • Phone: 405-631-0483
  • Fax: 405-561-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN D WILSON
Title or Position: CMO
Credential: DO
Phone: 405-631-0483