Healthcare Provider Details

I. General information

NPI: 1548056732
Provider Name (Legal Business Name): CLEARLY ALL PROVIDER LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 S 36TH WEST AVE
TULSA OK
74107-7404
US

IV. Provider business mailing address

5020 S 36TH WEST AVE
TULSA OK
74107-7404
US

V. Phone/Fax

Practice location:
  • Phone: 918-933-3022
  • Fax:
Mailing address:
  • Phone: 918-933-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: YASHICA ANN MORTON
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 918-933-3022