Healthcare Provider Details

I. General information

NPI: 1518853712
Provider Name (Legal Business Name): LUCAS RAWLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 BROADWAY EXT
OKLAHOMA CITY OK
73114-7408
US

IV. Provider business mailing address

18817 GROVE PKWY
EDMOND OK
73012-4499
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9000
  • Fax:
Mailing address:
  • Phone: 405-513-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberR0137449
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number224707
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: