OWASSO PEDIATRIC AND ADOLESCENT MEDICINE, P.L.C. (NPI# 1982624292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982624292 |
| Entity Type | Organization |
| Organization Name | OWASSO PEDIATRIC AND ADOLESCENT MEDICINE, P.L.C. |
| Practice Address |
12455 E 100th St N Suite 280 Owasso OK 74055-4600 |
| Practice Telephone | 9182749700 |
| Mailing Telephone | 9182749700 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. AARON HENLEY (PHYSICIAN) |
| Authorized Official Telephone | 9182749700 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
12455 E 100TH ST N SUITE 280 |
| City | OWASSO |
| State | OK |
| Zip Code | 74055-4600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306847264 | Michelle Marie Mcelroy | Obstetrics & Gynecology | 12455 E 100th St N, Ste 220, Owasso, OK 74055-4674 | 2005-08-02 |
| 1962824433 | Laura Corbin | Physician Assistant | 12455 E 100th St N, Ste 350, Owasso, OK 74055-4674 | 2014-01-17 |
| 1770850208 | Osu Center for Health Sciences | Clinic/Center | 12455 E 100th St N, Suite 110, Owasso, OK 74055-4674 | 2011-11-29 |
| 1679703607 | Kyle Charles Bennett | Optometrist | 12455 E 100th St N, Suite 110, Owasso, OK 74055-4674 | 2009-07-24 |
| 1427256940 | Caleb Nunley | Family Medicine | 12455 E 100th St N, Ste. 120, Owasso, OK 74055-4674 | 2007-07-05 |
| 1215054622 | Roger K Pfeiffer | Obstetrics & Gynecology | 12455 E 100th St N, Ste 220, Owasso, OK 74055-4674 | 2007-03-23 |
| 1972639722 | Owasso Eye Institute Inc | Optometrist | 12455 E 100th St N, Suite 110, Owasso, OK 74055-4600 | 2007-02-26 |
| 1760405740 | Charles Dennis Knife Chief | Obstetrics & Gynecology | 12455 E 100th St N, Ste 220, Owasso, OK 74055-4674 | 2006-07-25 |
| 1871516500 | Brian Scott Mcdowell | Pediatrics | 12455 E 100th St N, Suite 280, Owasso, OK 74055-4600 | 2006-07-25 |
| 1861439507 | Edwin C Waters | Family Medicine | 12455 E 100th St N, Suite 120, Owasso, OK 74055-4674 | 2006-06-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972151587 | Lakecrest Dental-owasso 96th | Dentist | 9551 N. Owasso Expressway, Suite #100, Owasso, OK 74055 | 2019-08-27 |
| 1205328697 | Eddie Duane Gaut | Case Manager/Care Coordinator | 110 W 3rd St., Apt 11, Owasso, OK 74055 | 2018-06-01 |
| 1821586694 | Kaitlyn Konarik | Speech-Language Pathologist | 12899 E 76th St N, Ste. 109, Owasso, OH 74055 | 2018-04-27 |
| 1043733769 | Kelsey Renae Nicklas | Case Manager/Care Coordinator | 9310 N 163rd East Ave, Owasso, OK 74055 | 2017-07-25 |
| 1700259256 | Genscripts Owasso, LLC | Pharmacy | 9538 N Garnett Rd, Suite 102, Owasso, OK 74055 | 2015-11-05 |
| 1770968810 | Premier Anesthesia Management Inc | Clinic/Center | 19236 E Twin Creeks Dr, Owasso, OK 74055 | 2015-07-29 |
| 1598152407 | Justin Lum | Physical Therapist | 12326 E 86th St N, Owasso, OK 74055 | 2015-04-17 |
| 1033507660 | Kimberly Louise Howard | Physical Therapy Assistant | 12899 East 76th St North, Owasso, OK 74055 | 2015-01-06 |
| 1780920629 | Timothy Ryan Thornton | Behavioral Analyst | 11330 N 94 E Ave, Owasso, OK 74055 | 2012-12-21 |
| 1679842785 | Kelli Marie Ellis | Counselor | 19760 E Fox Run Cir, Owasso, OK 74055 | 2011-12-19 |
| Find all providers in zip 74055 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902446917 | Chelsea Ryan Walker | Pediatrics | 12455 E 100th St N Ste 300, Owasso, OK 74055-4678 | 2020-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356544951 | Kristin Diane Conkling | Pediatrics | 5125 E 107th Pl, Tulsa, OK 74137-7236 | 2007-06-09 |
| 1780789362 | Children & Adolescent Medical Services Inc. | Pediatrics | 8803 S. 101st E. Ave., Suite 200, Tulsa, OK 74133 | 2006-09-14 |
| 1770504037 | Miguel Antonio Camacho-garrido | Pediatrics | 1104 Walnut Dr, Ardmore, OK 73401-2353 | 2006-07-22 |
| 1497788624 | Shelley Ann Bohn | Pediatrics | 937 Sw 89th St, Suite A, Oklahoma City, OK 73139-9231 | 2006-07-09 |
| 1922038348 | Paul Andrew Scott Benson | Pediatrics | 4444 E. 41st Street, 2nd Floor, Ou Physicians -- Pediatrics, Tulsa, OK 74135 | 2006-07-03 |
| 1235128430 | Elizabeth Gail Lewis | Pediatrics | 2701 Sw Cornell Ave, Lawton, OK 73505-7121 | 2005-10-19 |
| 1871581470 | Charles R Mettry | Pediatrics | 201 N Monte Vista St, Suite B, Ada, OK 74820-7200 | 2005-10-10 |
| 1578568010 | Julie Gail Sullivan | Pediatrics | 1615 S Eucalyptus Ave, Suite 210, Broken Arrow, OK 74012-6159 | 2005-06-20 |
| 1609005842 | Ahmad Pediatrics | Pediatrics | 302 E Downing St, Tahlequah, OK 74464-3014 | 2009-07-09 |
| 1235399122 | South Pointe Pediatrics, Pllc | Pediatrics | 1615 S Eucalyptus Ave, Suite 210, Broken Arrow, OK 74012-6159 | 2008-06-13 |
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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.