MEDICARE: KALEY MAE GILLIAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1851225106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEY MAE GILLIAM

Provider Business Mailing Address
First Line	:	8365 E 160TH ST S
Second Line	:
City	:	BIXBY
State	:	OK
Zip	:	74008-6233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	SKYLINE EAST II, 6128 E 38TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135
Country	:	US
Telephone Number	:	844-458-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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