Healthcare Provider Details

I. General information

NPI: 1134962145
Provider Name (Legal Business Name): LAUREN PENDARVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN HARTSELL DO

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 6TH AVE
STILLWATER OK
74074-4399
US

IV. Provider business mailing address

411 TOPAZ AVE
STILLWATER OK
74075-1887
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-1480
  • Fax:
Mailing address:
  • Phone: 580-302-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1125R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: