Healthcare Provider Details

I. General information

NPI: 1235075508
Provider Name (Legal Business Name): INTEGRATIVE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 WOODTHRUSH RD
PONCA CITY OK
74604-2830
US

IV. Provider business mailing address

2305 WOODTHRUSH RD
PONCA CITY OK
74604-2830
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-9781
  • Fax:
Mailing address:
  • Phone: 405-757-9781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR G LEWIS
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: APRN
Phone: 405-757-9781