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Organization
DISCOVERY WELLNESS LLC
Active
Organization
DISCOVERY WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW BLAKEMAN (OPERATIONS MANAGER)
(405) 210-1662
Entity
Organization
Contact information
Practice address
17625 LEAD LN, EDMOND, OK 73012-6959
(405) 210-1662
Mailing address
17625 LEAD LN, EDMOND, OK 73012-6959
(405) 210-1662
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NULL
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200294910A
—
OK
01
—
78861
OKLAHOMA NURSING LISCENSE
OK
Enumeration date
09/23/2015
Last updated
03/07/2023
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