Provider Demographics
NPI:1053287029
Name:NATIVE WELLNESS LLC
Entity type:Organization
Organization Name:NATIVE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-618-1109
Mailing Address - Street 1:410 E TULSA AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-2845
Mailing Address - Country:US
Mailing Address - Phone:580-359-0597
Mailing Address - Fax:580-203-3241
Practice Address - Street 1:410 E TULSA AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-2845
Practice Address - Country:US
Practice Address - Phone:580-359-0597
Practice Address - Fax:580-203-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty