Provider Demographics
NPI:1265610471
Name:SPEEGLE, LYUBOV LYNN (PAC)
Entity type:Individual
Prefix:MRS
First Name:LYUBOV
Middle Name:LYNN
Last Name:SPEEGLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LIUBOV
Other - Middle Name:YURIEVNA
Other - Last Name:KARTASHOVEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10100 MILLSPAUGH WAY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7975
Mailing Address - Country:US
Mailing Address - Phone:405-615-1178
Mailing Address - Fax:
Practice Address - Street 1:4107 N COUNCIL RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3131
Practice Address - Country:US
Practice Address - Phone:405-889-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1685363AM0700X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical