Healthcare Provider Details

I. General information

NPI: 1083545214
Provider Name (Legal Business Name): WADE WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 5TH ST RM 101
PAWNEE OK
74058-2590
US

IV. Provider business mailing address

341270 E 5100 RD
GLENCOE OK
74032-2278
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-7846
  • Fax:
Mailing address:
  • Phone: 480-242-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONDA WADE
Title or Position: OWNER/MEDICAL PROVIDER
Credential: CNP
Phone: 480-242-7846