Healthcare Provider Details

I. General information

NPI: 1770496853
Provider Name (Legal Business Name): PUREPATH MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 N 157TH EAST AVE
OWASSO OK
74055-8545
US

IV. Provider business mailing address

9001 N 157TH EAST AVE
OWASSO OK
74055-8545
US

V. Phone/Fax

Practice location:
  • Phone: 918-277-5588
  • Fax:
Mailing address:
  • Phone: 918-277-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBIN GAIL SHORT
Title or Position: OWNER
Credential: CNP
Phone: 918-277-5588