NPIMap

Organization Active NPI

Vibrant Life Direct Care, PLLC

  • Primary Care Clinic/Center
  • Tuttle, OK
National Provider Identifier
1730880212
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
VIBRANT LIFE DIRECT CARE, PLLC
Practice address
2618 E Highway 37 Ste 100
Tuttle, OK 73089-8479
Phone
(405) 376-1381
Fax
(800) 488-3294
NPI assigned
Mar 13, 2023
Organization subpart
Yes
Parent organization
VIBRANT LIFE DIRECT CARE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Authorized official

Name
Dr. Lydia Jemison Dennis, DONPI 1083724546
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)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

2618 E Highway 37 Ste 100
Tuttle, OK 73089-8479

Mailing address

2618 E Highway 37 Ste 100
Tuttle, OK 73089-8479
Phone (405) 376-1381

Other names 1

  • Vibrant Life Direct Care Tuttle Other name

National Provider Directory

National Provider Directory
Tax ID family
Vibrant Life Direct Care PLLC2 organizations share this tax ID, including this one
Part of
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.

Locations

2618 E Highway 37
Ste 100
Tuttle, OK 73089
Phone (405) 376-1381

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1730880212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2618 E HIGHWAY 37 STE 100",
            "city": "TUTTLE",
            "state": "OK",
            "postal_code": "730898479",
            "telephone_number": "405-376-1381",
            "fax_number": "800-488-3294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2618 E HIGHWAY 37 STE 100",
            "city": "TUTTLE",
            "state": "OK",
            "postal_code": "730898479",
            "telephone_number": "405-376-1381",
            "fax_number": "800-488-3294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT LIFE DIRECT CARE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIBRANT LIFE DIRECT CARE, PLLC",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "JEMISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-708-3385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vibrant Life Direct Care Tuttle",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tuttle, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.