Healthcare Provider Details

I. General information

NPI: 1477572089
Provider Name (Legal Business Name): JAMES AARON HENLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E 5TH AVE STE 105
OWASSO OK
74055-3484
US

IV. Provider business mailing address

314 E 5TH AVE STE 105
OWASSO OK
74055-3484
US

V. Phone/Fax

Practice location:
  • Phone: 918-608-0348
  • Fax: 918-923-3884
Mailing address:
  • Phone: 918-608-0348
  • Fax: 918-923-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4195
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: