Divine Health and Wellness, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

DIVINE HEALTH AND WELLNESS, LLC

Practice address

16 S Water St
Sapulpa, OK 74066-4232

Phone

(918) 347-9022

NPI assigned

Jun 14, 2024

Last updated

Jun 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samantha A Bryan

Title

Director

Phone

(918) 510-4349

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Jeremy Lee, A.R.N.P

  • Family Nurse Practitioner
  • Claremore, OK
  • NPI 1306857123
  Medicare reassignment NPD
• Carlyn E Tackett, APRN

  • Family Nurse Practitioner
  • Sapulpa, OK
  • NPI 1720610587
  Medicare reassignment NPD
• Shea Lyn Despain, APRN

  • Family Nurse Practitioner
  • Sapulpa, OK
  • NPI 1457050114
  NPD
• Mary Peeples, APRN-CNP

  • Nurse Practitioner
  • Broken Arrow, OK
  • NPI 1932824455
  NPD (past)
• Kristina Marie Stout, APRN-CNP

  • Nurse Practitioner
  • Tulsa, OK
  • NPI 1629789276
  NPD (past)

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

{
    "created_epoch": "1718323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1790528164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 S WATER ST",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664232",
            "telephone_number": "918-347-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 S WATER ST",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664232",
            "telephone_number": "918-347-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-14",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "918-510-4349"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas A Derstine, DC
• Shea Lyn Despain, APRN
• Brandi D Detherow, LCSW PROVISIONAL
• Aida Araceli Dicken
• Anthony Diskin, DDS
• Mai Thi DO
• Dayen Ann Dooley
• Matt W. X. Dooley, MA, MAMFT
• Angela Doran, OTR/L
• Ayden Draper

• Health Service Clinic/Center in Sapulpa, OK
• Providers in Sapulpa, OK by specialty
• Health Service Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.