Active NPI
Vibrant Life Direct Care, PLLC
- Family Medicine Physician
- Mustang, OK
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- VIBRANT LIFE DIRECT CARE, PLLC
- Doing business as
- Vibrant Life Direct Care, PLLC
- Practice address
- 501 N Mustang Rd Ste B
Mustang, OK 73064-7044 - Phone
- (405) 708-3385
- Fax
- (800) 488-3294
- NPI assigned
- Jan 17, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Lydia J. Dennis, DO
- Title
- Owner
- Phone
- (405) 708-3385
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
501 N Mustang Rd Ste B
Mustang, OK 73064-7044
Mailing address
5225 E Tyler Dr
Tuttle, OK 73089-8305
Phone (405) 708-3385
Other names 1
- Vibrant Life Direct Care, PLLC
National Provider Directory
National Provider Directory- Tax ID family
- Vibrant Life Direct Care PLLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Clinic/Center
- Tuttle, OK
- NPI 1730880212
Locations
501 N Mustang Rd
Ste B
Mustang, OK 73064
Phone (405) 376-1381
Ownership & related parties
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Primary Care Clinic/Center
- Tuttle, OK
- NPI 1730880212
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Yukon, OK
- NPI 1083724546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579219200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1579219200000",
"number": "1295365302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5225 E TYLER DR",
"city": "TUTTLE",
"state": "OK",
"postal_code": "730898305",
"telephone_number": "405-708-3385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 N MUSTANG RD STE B",
"city": "MUSTANG",
"state": "OK",
"postal_code": "730647044",
"telephone_number": "405-708-3385",
"fax_number": "800-488-3294"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VIBRANT LIFE DIRECT CARE, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-01-17",
"last_updated": "2020-01-17",
"certification_date": "2020-01-17",
"status": "A",
"authorized_official_last_name": "DENNIS",
"authorized_official_first_name": "LYDIA",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "405-708-3385",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Vibrant Life Direct Care, PLLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mustang, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.