NPIMap

Organization Active NPI

Libertad Wellness Center LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1295583508
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LIBERTAD WELLNESS CENTER LLC
Practice address
2915 N Classen Blvd Ste 120-F509
Oklahoma City, OK 73106-5400
Phone
(405) 689-9303
Fax
(405) 229-5071
NPI assigned
May 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Prudencia Ijeoma Tankeu, PMHNP-BC
Title
Manager
Phone
(405) 689-9303

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health & Wellness CoachGroup: 193200000X MULTI-SPECIALTY GROUP 171400000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

2915 N Classen Blvd Ste 120-F509
Oklahoma City, OK 73106-5400

Mailing address

2915 N Classen Blvd Ste 120-F509
Oklahoma City, OK 73106-5400
Phone (405) 689-9303

National Provider Directory

National Provider Directory

Locations

2915 N Classen Blvd
Ste 120F509
Oklahoma City, OK 73106
Phone (405) 689-9303

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1295583508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 N CLASSEN BLVD STE 120-F509",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731065400",
            "telephone_number": "405-689-9303",
            "fax_number": "405-229-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 N CLASSEN BLVD STE 120-F509",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731065400",
            "telephone_number": "405-689-9303",
            "fax_number": "405-229-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTAD WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "IJEOMA TANKEU",
        "authorized_official_first_name": "PRUDENCIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-689-9303",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.