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General NPI Number Information
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NPI Number | 1558294140
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Entity Type | Organization
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Legal Business Name | GRITTS WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 2067 MAHANEY AVE
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City | TAHLEQUAH
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State | OK
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Zip | 74464-5731
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Country | US
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Telephone | 918-931-3188
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Fax | 918-398-9259
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Provider Business Mailing Address
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Address Line | 156 REASOR ST # 246
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City | TAHLEQUAH
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State | OK
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Zip | 74464-5726
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Country | US
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Telephone | 918-931-3188
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Fax | 918-398-9259
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Authorized Official
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Title or Position | OWNER
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Name | CHARITY GRITTS
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Credential | APRN
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Telephone | 918-931-3188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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