Individual
LARRY RAY TEVEBAUGH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
4400 GRANT BLVD, YUKON, OK 73099-0037
(405) 830-5574
Mailing address
4400 GRANT BLVD, YUKON, OK 73099-0037
(405) 787-8550
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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