=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629939111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRETT WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5508 S LEWIS AVE STE 200
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74105-7105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-895-1129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5530 S VANCOUVER PL
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74107-9064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-581-3343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/HEALTH COACH/NUTRITIONIST
-----------------------------------------------------
Name | MRS. JACQUELINE SHERRY WADE
-----------------------------------------------------
Credential | CN, BHC, BMHC, IINHC
-----------------------------------------------------
Telephone | 918-581-3343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------