# WILLOW MEDICAL LLC

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

## Provider details

- **NPI number:** 1417640582
- **Authorized official:** PAULA MOORMAN APRN, FNP-C (APRN, FNP-C)
- **Authorized official phone:** (539) 208-5069

## Contact information

- **Practice address:** 12806 E 86TH PL N STE A, OWASSO, OK 74055-2688
- **Practice address phone:** (539) 208-5069
- **Practice address fax:** (539) 208-5440
- **Mailing address:** 12806 E 86TH PL N STE A, OWASSO, OK 74055-2688
- **Mailing address phone:** (539) 208-5069
- **Mailing address fax:** (539) 208-5440

## Taxonomy

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

## Other

- **Enumeration date:** 06/02/2023
- **Last updated:** 10/12/2026