| Your Health & Wellness | |
|
400 N Eastern Ave Moore OK 73160-5833 | |
| (405) 730-6990 | |
| Not Available |
| Full Name | Your Health & Wellness |
|---|---|
| Speciality | Family Medicine |
| Location | 400 N Eastern Ave, Moore, Oklahoma |
| Authorized Official Name and Position | Lesley Henthorn (CREDENTIALING) |
| Authorized Official Contact | 4052373770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Health & Wellness Po Box 892410 Oklahoma City OK 73189-2410 Ph: (405) 735-9348 | Your Health & Wellness 400 N Eastern Ave Moore OK 73160-5833 Ph: (405) 730-6990 |
| NPI Number | 1396385431 |
|---|---|
| Provider Enumeration Date | 01/07/2020 |
| Last Update Date | 09/16/2025 |
| Certification Date | 09/16/2025 |
| Medicare PECOS PAC ID | 3870922008 |
|---|---|
| Medicare Enrollment ID | O20200408004584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396385431 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | () | Secondary |
| Provider Name | Joe B Bourland |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1306827373 PECOS PAC ID: 4284728916 Enrollment ID: I20070925000594 |
| Provider Name | Brett D Purvis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1215193982 PECOS PAC ID: 1153487095 Enrollment ID: I20090302000540 |
| Provider Name | John E Beavers |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386615839 PECOS PAC ID: 1355481995 Enrollment ID: I20091212000114 |
| Provider Name | Mallory Jo Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255963252 PECOS PAC ID: 7113357567 Enrollment ID: I20200427000354 |
| Provider Name | Kyle M Mccall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134871080 PECOS PAC ID: 8820447824 Enrollment ID: I20231216000033 |
| Provider Name | Mary G Difuntorum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659078129 PECOS PAC ID: 6305372681 Enrollment ID: I20241210002877 |
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