Provider Demographics
NPI:1992692743
Name:PURE FLOW WELLNESS LLC
Entity type:Organization
Organization Name:PURE FLOW WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NP
Authorized Official - Prefix:
Authorized Official - First Name:REANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:918-960-0926
Mailing Address - Street 1:1215 N BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2690
Mailing Address - Country:US
Mailing Address - Phone:918-960-0926
Mailing Address - Fax:
Practice Address - Street 1:1215 N BIRCH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2690
Practice Address - Country:US
Practice Address - Phone:918-960-0926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty