Healthcare Provider Details

I. General information

NPI: 1073202792
Provider Name (Legal Business Name): 918 FAMILY WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 N 123RD EAST AVE
OWASSO OK
74055-2130
US

IV. Provider business mailing address

8430 N 123RD EAST AVE
OWASSO OK
74055-2130
US

V. Phone/Fax

Practice location:
  • Phone: 918-401-4770
  • Fax: 918-401-4779
Mailing address:
  • Phone: 918-401-4770
  • Fax: 918-401-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA ALLEN
Title or Position: OWNER, NURSE PRACTITIONER
Credential: APRN FNP-C
Phone: 918-401-4770