NPI Code Detail JSON Logo

1053287029 NPI number — NATIVE WELLNESS LLC

NPI Number: 1053287029
Health Care Provider/Practitioner: NATIVE WELLNESS LLC

Information about “1053287029” NPI (NATIVE WELLNESS LLC) exists in 1053287029 in HTML format HTML  |  1053287029 in plain Text format TXT  |  1053287029 in PDF (Portable Document Format) PDF  |  1053287029 in an XML format XML  formats.

NPI Number : 1053287029 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053287029",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NATIVE WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "410 E TULSA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SULPHUR",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73086-2845",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "580-359-0597",
    "MailingAddressFaxNumber": "580-203-3241",
    "FirstLinePracticeLocationAddress": "1432 W BROADWAY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SULPHUR",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73086-4216",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "580-359-0597",
    "PracticeLocationAddressFaxNumber": "580-203-3241",
    "EnumerationDate": "10/15/2025",
    "LastUpdateDate": "10/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "O'DELL",
    "AuthorizedOfficialFirstName": "LAKRISTA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MEMBER / OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RN",
    "AuthorizedOfficialTelephoneNumber": "580-618-1109",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM2500X",
          "TaxonomyName": "Medical Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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