Healthcare Provider Details

I. General information

NPI: 1326953233
Provider Name (Legal Business Name): BONE RESTORATION AND WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8556 E 101ST ST STE G
TULSA OK
74133-7036
US

IV. Provider business mailing address

8556 E 101ST ST STE G
TULSA OK
74133-7036
US

V. Phone/Fax

Practice location:
  • Phone: 813-294-2208
  • Fax:
Mailing address:
  • Phone: 813-294-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN BALL
Title or Position: OWNER / PROVIDER
Credential: PA
Phone: 208-315-1340