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General NPI Number Information
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NPI Number | 1902764053
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH ALLIANCE GROUP
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 2104 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-5356
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Country | US
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Telephone | 918-999-9339
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Fax | 918-238-9990
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Provider Business Mailing Address
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Address Line | 828 A ST NW
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City | MIAMI
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State | OK
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Zip | 74354-4605
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Country | US
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Telephone | 918-999-9339
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Fax | 918-238-9990
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SERENA BROOKE WILSON
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Credential | APRN
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Telephone | 918-961-1658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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