| Kavanah Medical Llc | |
|
11560 N 135th East Ave Owasso OK 74055-5755 | |
| (918) 553-1188 | |
| (918) 553-1189 |
| Full Name | Kavanah Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 11560 N 135th East Ave, Owasso, Oklahoma |
| Authorized Official Name and Position | Kristina M Doolittle (OWNER / NURSE PRACTITIONER) |
| Authorized Official Contact | 9185531188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kavanah Medical Llc Po Box 844 Owasso OK 74055-0844 Ph: (918) 553-1188 | Kavanah Medical Llc 11560 N 135th East Ave Owasso OK 74055-5755 Ph: (918) 553-1188 |
| NPI Number | 1548807993 |
|---|---|
| Provider Enumeration Date | 12/04/2019 |
| Last Update Date | 03/23/2021 |
| Medicare PECOS PAC ID | 9032544226 |
|---|---|
| Medicare Enrollment ID | O20200116000840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548807993 | NPI | - | NPPES |
| 95706 | Other | OK | OKLAHOMA NURSING BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jayme Marie Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912333154 PECOS PAC ID: 0345468419 Enrollment ID: I20140903000308 |
| Provider Name | Warren Hancock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902196728 PECOS PAC ID: 9436380581 Enrollment ID: I20151006001220 |
| Provider Name | Kristina Marie Doolittle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306353552 PECOS PAC ID: 4284995952 Enrollment ID: I20180221002317 |
| Provider Name | Tracy Lynn Stuckey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861093379 PECOS PAC ID: 6901218106 Enrollment ID: I20201211001705 |
| Provider Name | Rebekah Ann Fairchild |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386317915 PECOS PAC ID: 3971900812 Enrollment ID: I20210921000556 |
| Provider Name | Alejandra Gabriela Paredes Mares |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295478360 PECOS PAC ID: 7719362425 Enrollment ID: I20220916000650 |
| Provider Name | Leah Rachel Loyd |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1104325844 PECOS PAC ID: 2668857913 Enrollment ID: I20220922001217 |
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