Larry Walter Church
Individual provider Active NPI Registered Nurse · Prague, OK
NPI 1285501783 · NPPES record last updated Oct 24, 2025
Key facts
- NPI
- 1285501783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R0027933 (OK)
- Practice address
- 57523 Moccasin Trail Rd
Prague, OK 74864-1143 - Phone
- (405) 567-0054
- Fax
- (405) 567-0055
- NPI assigned
- Oct 20, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0027933 | OK | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Land of Hope | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R0027933 | OK | Yes |
Addresses
Primary practice location
57523 Moccasin Trail Rd
Prague, OK 74864-1143
Mailing address
57523 Moccasin Trail Rd
Prague, OK 74864-1143
Phone (405) 567-0054
Other providers in Prague, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.