Provider Demographics
NPI:1629864517
Name:HEALTHYSPAN LLC
Entity type:Organization
Organization Name:HEALTHYSPAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP, APRN-CNP
Authorized Official - Prefix:
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, APRN-CNP
Authorized Official - Phone:405-822-0480
Mailing Address - Street 1:10324 GREENBRIAR PL STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7650
Mailing Address - Country:US
Mailing Address - Phone:405-822-0480
Mailing Address - Fax:947-222-9272
Practice Address - Street 1:10324 GREENBRIAR PL STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7650
Practice Address - Country:US
Practice Address - Phone:405-822-0480
Practice Address - Fax:947-222-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty