# VIBRANT LIFE DIRECT CARE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vibrant Life Direct Care, PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295365302
- **Authorized official:** DR. LYDIA J. DENNIS DO (OWNER)
- **Authorized official phone:** (405) 708-3385

## Contact information

- **Practice address:** 501 N MUSTANG RD STE B, MUSTANG, OK 73064-7044
- **Practice address phone:** (405) 708-3385
- **Practice address fax:** (800) 488-3294
- **Mailing address:** 5225 E TYLER DR, TUTTLE, OK 73089-8305
- **Mailing address phone:** (405) 708-3385

## Taxonomy

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

## Other

- **Enumeration date:** 01/17/2020
- **Last updated:** 01/17/2020