Provider Demographics
NPI:1245118652
Name:MARTIN, LINDA (LPN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8516 E 123RD ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2714
Mailing Address - Country:US
Mailing Address - Phone:918-883-5632
Mailing Address - Fax:918-883-5632
Practice Address - Street 1:8516 E 123RD ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2714
Practice Address - Country:US
Practice Address - Phone:918-883-5632
Practice Address - Fax:918-883-5632
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58128164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty