Healthcare Provider Details

I. General information

NPI: 1699630210
Provider Name (Legal Business Name): LAUREN DANIELLE ELLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N GREENWOOD AVE
TULSA OK
74120-1444
US

IV. Provider business mailing address

10703 S 280TH EAST AVE
COWETA OK
74429-9011
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7277
  • Fax:
Mailing address:
  • Phone: 918-704-3443
  • Fax: 918-704-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: