Healthcare Provider Details

I. General information

NPI: 1376353532
Provider Name (Legal Business Name): LAUREN KATE NEELY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W WRANGLER BLVD
SEMINOLE OK
74868-1917
US

IV. Provider business mailing address

4201 W WRANGLER BLVD
SEMINOLE OK
74868
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-3650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5446
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: