VIBRANT LIFE DIRECT CARE, PLLC (NPI# 1295365302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295365302 |
| Entity Type | Organization |
| Organization Name | VIBRANT LIFE DIRECT CARE, PLLC |
| Practice Address |
501 N Mustang Rd Ste B Mustang OK 73064-7044 |
| Mailing Address |
5225 E Tyler Dr Tuttle OK 73089-8305 |
| Practice Telephone | 4057083385 |
| Practice Fax Number | 8004883294 |
| Mailing Telephone | 4057083385 |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |
| Authorized Official Name | DR. LYDIA J. DENNIS (OWNER) |
| Authorized Official Telephone | 4057083385 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Vibrant Life Direct Care, PLLC | Doing Business As Name - Organization |
| Street Address |
501 N MUSTANG RD STE B |
| City | MUSTANG |
| State | OK |
| Zip Code | 73064-7044 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336760149 | Brian Angel Padilla | Student in an Organized Health Care Education/Training Program | 704 N White Tail Way, Mustang, OK 73064 | 2020-05-03 |
| 1346762564 | Mustang Dentistry & Braces | Clinic/Center | 1001 E. Highway 152, Suite 113, Mustang, OK 73064 | 2017-07-10 |
| 1134591779 | James Donald Mcginn IIi | Nurse Practitioner | 738 W. Perry, Mustang, OK 73064 | 2015-10-22 |
| 1912310681 | Jon Austin Barnes | Dentist | 201 S Sara Rd Ste 140, Mustang, OK 73064 | 2014-06-10 |
| 1770996084 | Jennifer Chadd Wilbourn | Dentist | 500 N Financial Center Terrace, Suite D, Mustang, OK 73064 | 2014-06-04 |
| 1003236969 | Okc Dental Health Associates, P.C. | Dentist | 1041 E. Hwy 152, Mustang, OK 73064 | 2014-04-18 |
| 1063834786 | Heather Wagner | Nurse Practitioner | 106 W Highway 152, Mustang, OK 73064 | 2014-01-15 |
| 1053743252 | Misty Renee May | Counselor | 1558 E. Lake Aire Lane, Mustang, OK 73064 | 2013-07-30 |
| 1386901502 | John M Ketcher LLC | Optometrist | 1108 E. Hwy 152, Mustang, OK 73064 | 2012-04-12 |
| 1083995658 | Joseph J Gronigan | Counselor | 627 E Suera Terr., Mustang, OK 73064 | 2011-09-08 |
| Find all providers in zip 73064 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356506935 | Peter Paul Bullock Jr. | Family Medicine | 106 S Castlerock Ln, Mustang, OK 73064-4586 | 2008-07-23 |
| 1770788358 | Joy Alyse Manning Plain | Family Medicine | 201 S Sara Road, Suite 200, Mustang, OK 73064 | 2007-06-15 |
| 1811103922 | Saints Medical Group, LLC | Family Medicine | 501 N Mustang Rd, Suite D, Mustang, OK 73064-7048 | 2007-05-15 |
| 1235271719 | Ilona Dobrowolska Samara | Family Medicine | 201 S Sara Rd, Suite 200, Mustang, OK 73064-4303 | 2007-02-13 |
| 1285662890 | Rebecca G. Biorato | Family Medicine | 731 E State Highway 152, Mustang, OK 73064-4520 | 2006-06-30 |
| 1710989702 | Gerald A Amundsen II | Family Medicine | 206 N Mustang Mall Ter, Mustang, OK 73064-5135 | 2005-08-10 |
| 1013397991 | Chelsea R Mcvey | Family Medicine | 1468 N Mustang Rd, Mustang, OK 73064-7214 | 2015-06-04 |
| 1336569417 | Leslie Williams | Family Medicine | 201 S Sara Rd Ste 200, Mustang, OK 73064-4308 | 2014-04-16 |
| 1881955508 | Erin Balzer | Family Medicine | 1468 N Mustang Rd, Mustang, OK 73064-7214 | 2012-05-30 |
| 1740577279 | Stefanie Lynn Meredith | Family Medicine | 1468 N Mustang Rd, Mustang, OK 73064-7214 | 2011-07-05 |
| Find all providers in MUSTANG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.