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General NPI Number Information
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NPI Number | 1053287029
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Entity Type | Organization
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Legal Business Name | NATIVE WELLNESS LLC
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1432 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4216
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Country | US
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Telephone | 580-359-0597
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Fax | 580-203-3241
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Provider Business Mailing Address
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Address Line | 410 E TULSA AVE
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City | SULPHUR
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State | OK
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Zip | 73086-2845
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Country | US
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Telephone | 580-359-0597
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Fax | 580-203-3241
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Authorized Official
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Title or Position | MEMBER / OWNER
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Name | LAKRISTA O'DELL
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Credential | RN
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Telephone | 580-618-1109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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