# NR STILLWATER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** NERVE RENEWAL STILLWATER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518708635
- **Authorized official:** TIMOTHY C BALES (OWNER/CEO)
- **Authorized official phone:** (405) 953-7221

## Contact information

- **Practice address:** 1411 W 12TH AVE STE D, STILLWATER, OK 74074-5482
- **Practice address phone:** (405) 724-6902
- **Practice address fax:** (405) 669-3517
- **Mailing address:** 3705 NW 63RD ST STE 200, OKLAHOMA CITY, OK 73116-1937
- **Mailing address phone:** (405) 953-7221
- **Mailing address fax:** (405) 669-3517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/03/2024
- **Last updated:** 08/13/2026