Healthcare Provider Details

I. General information

NPI: 1609705946
Provider Name (Legal Business Name): LAUREN PHARAOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24962 OKAY RD
TECUMSEH OK
74873-6504
US

IV. Provider business mailing address

9901 ESSEX AVE
OKLAHOMA CITY OK
73120-4019
US

V. Phone/Fax

Practice location:
  • Phone: 405-829-6740
  • Fax:
Mailing address:
  • Phone: 405-618-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: