Provider Demographics
NPI:1669102968
Name:POGUE, LAUREN KRISTINE
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:KRISTINE
Last Name:POGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9724 S 70TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5903
Mailing Address - Country:US
Mailing Address - Phone:191-899-1576
Mailing Address - Fax:
Practice Address - Street 1:9724 S 70TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5903
Practice Address - Country:US
Practice Address - Phone:918-991-5768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKYUQ947076181OtherBLUECROSS BLUESHIELD OF OKLAHOMA