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Individual
LARRY RAY TEVEBAUGH JR.
Active
Individual
LARRY RAY TEVEBAUGH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
R0094181
OK
363L00000X
Nurse Practitioner
Primary
1619560984
OK
Other
Enumeration date
02/17/2021
Last updated
05/11/2026
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