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General NPI Number Information
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NPI Number | 1528938263
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Entity Type | Organization
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Legal Business Name | PRAIRIE ROSE MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 4411 W GORE BLVD STE A2
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City | LAWTON
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State | OK
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Zip | 73505-5977
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Country | US
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Telephone | 405-501-5254
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Fax |
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Provider Business Mailing Address
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Address Line | 6 NW PLEASANT VIEW RDG
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City | LAWTON
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State | OK
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Zip | 73505-9503
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Country | US
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Telephone | 405-501-5254
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE YORE
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Credential | PA
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Telephone | 405-501-5254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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