Evolution Hair Care,LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

94711 Issued in OK

Legal business name

EVOLUTION HAIR CARE,LLC

Practice address

11102 Stratford Dr Ste B200
Oklahoma City, OK 73120-7263

Phone

(405) 501-6402

NPI assigned

Aug 26, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Shiron Janean Bullock

Title

Hair Loss Specialist

Phone

(405) 501-6402

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1851847297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12429 PITTSBURGH AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731206000",
            "telephone_number": "405-501-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11102 STRATFORD DR STE B200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731207263",
            "telephone_number": "405-501-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION HAIR CARE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "SHIRON",
        "authorized_official_middle_name": "JANEAN",
        "authorized_official_title_or_position": "HAIR LOSS SPECIALIST",
        "authorized_official_telephone_number": "405-501-6402",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OK",
            "license": "94711",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "OK",
            "license": "94711",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OK",
            "license": "94711",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "OK",
            "license": "94711",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "OK",
            "license": "94711",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "OK",
            "license": "94711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Prosthetic/Orthotic Supplier in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.