MEDICARE: DYNAMIC WOUND CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1598541427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC WOUND CARE LLC

Provider Business Mailing Address
First Line	:	2222 SHADOWLAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7440
Country	:	US
Telephone Number	:	405-315-8440
Fax Number	:	405-653-1444

Provider Business Practice Location Address
First Line	:	2222 SHADOWLAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7440
Country	:	US
Telephone Number	:	405-315-8440
Fax Number	:	405-653-1444

Authorized Official
Title or Position	:	OWNER
Name	:	BRENT BYERS
Credential	:	MSN, FNP, AGACNP-BC
Telephone Number	:	405-315-8440

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/30/2025

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