# REGENERATION NATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164060158
- **Authorized official:** BRIAN ROADHOUSE (OWNER, AUTHORIZED OFFICIAL)
- **Authorized official phone:** (918) 481-2772

## Contact information

- **Practice address:** 6565 S YALE AVE STE 106, TULSA, OK 74136-8302
- **Practice address phone:** (918) 481-2772
- **Mailing address:** 6565 S YALE AVE, TULSA, OK 74136-8327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | — |
| 207K00000X | Allergy & Immunology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2019
- **Last updated:** 03/26/2024