Healthcare Provider Details

I. General information

NPI: 1184550782
Provider Name (Legal Business Name): LOU LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W ELM AVE
STILLWATER OK
74074-3509
US

IV. Provider business mailing address

PO BOX 172
PERKINS OK
74059-0172
US

V. Phone/Fax

Practice location:
  • Phone: 405-338-9344
  • Fax: 405-338-9345
Mailing address:
  • Phone: 405-338-9344
  • Fax: 405-338-9345

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: JASMINE BOYD
Title or Position: OWNER
Credential:
Phone: 405-338-9344