Healthcare Provider Details

I. General information

NPI: 1629939111
Provider Name (Legal Business Name): BARRETT WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 S LEWIS AVE STE 200
TULSA OK
74105-7105
US

IV. Provider business mailing address

5530 S VANCOUVER PL
TULSA OK
74107-9064
US

V. Phone/Fax

Practice location:
  • Phone: 918-895-1129
  • Fax:
Mailing address:
  • Phone: 918-581-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE SHERRY WADE
Title or Position: OWNER/HEALTH COACH/NUTRITIONIST
Credential: CN, BHC, BMHC, IINHC
Phone: 918-581-3343