Provider Demographics
NPI:1962632539
Name:LEHR, PHILIP JOHN (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:LEHR
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132
Mailing Address - Country:US
Mailing Address - Phone:918-749-0762
Mailing Address - Fax:918-744-4246
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:#300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-749-0762
Practice Address - Fax:918-744-4246
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR95164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200323130AMedicaid
OKR95164OtherLICENSE
OKR95164OtherLICENSE