Healthcare Provider Details

I. General information

NPI: 1912832817
Provider Name (Legal Business Name): LAUREN MARTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N PORTLAND AVE
OKLAHOMA CITY OK
73112-2074
US

IV. Provider business mailing address

2720 CHAUCER DR
OKLAHOMA CITY OK
73120-2707
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-6000
  • Fax:
Mailing address:
  • Phone: 970-231-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5883
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: