Healthcare Provider Details

I. General information

NPI: 1699668426
Provider Name (Legal Business Name): VINEYARD MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11917 S NORWOOD AVE
TULSA OK
74137-5509
US

IV. Provider business mailing address

11917 S NORWOOD AVE # 212
TULSA OK
74137-5509
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-5555
  • Fax: 918-392-5566
Mailing address:
  • Phone: 918-392-5555
  • Fax: 918-392-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KYRA JEAN VINEYARD
Title or Position: OWNER
Credential: D.O.
Phone: 918-392-5555