Healthcare Provider Details

I. General information

NPI: 1629997663
Provider Name (Legal Business Name): PEDIATRIC CARE COORDINATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6314 E 89TH ST N
OWASSO OK
74055-8562
US

IV. Provider business mailing address

6314 E 89TH ST N
OWASSO OK
74055-8562
US

V. Phone/Fax

Practice location:
  • Phone: 918-257-6629
  • Fax: 918-398-9262
Mailing address:
  • Phone: 918-257-6629
  • Fax: 918-398-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHELSEA LYNN RIDENER
Title or Position: APRN-CNP
Credential: DNP
Phone: 254-592-0895