Healthcare Provider Details

I. General information

NPI: 1649565821
Provider Name (Legal Business Name): JOHN H KEPHART D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E. 41ST STREET SUITE 900
TULSA OK
74135-5631
US

IV. Provider business mailing address

PO BOX 4930
TULSA OK
74159-0930
US

V. Phone/Fax

Practice location:
  • Phone: 918-934-8347
  • Fax: 918-743-8552
Mailing address:
  • Phone: 918-934-8347
  • Fax: 918-743-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT014362
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5761
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: