NPI 1710134580

Dr. Lively's Child & Family Wellness Ctr. PC

Organisation Exclusive Provider Organization Cushing, OK

Practice location

Address: 5505 Ew 75th Rd, Cushing, OK 74023-5555
Phone: (918) 225-3137
Fax: (918) 355-0298
Mailing address: PO Box 990, Cushing, OK 74023-0990

Authorised official

Name: Kathy Lynn Lively
Title: Director
Phone: (918) 225-3137

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 766 (OK)

Other Exclusive Provider Organization providers in Oklahoma →

Registry record

NPI: 1710134580
Entity type: Organization
NPI issued: 25 Aug 2008
Record last updated: 25 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.