Healthcare Provider Details

I. General information

NPI: 1417014440
Provider Name (Legal Business Name): MELINDA R ALLEN-CULLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W 4TH
CANEY KS
67333-1462
US

IV. Provider business mailing address

226 SE DEBELL BLDG A
BARTLESVILLE OK
74006
US

V. Phone/Fax

Practice location:
  • Phone: 620-879-2182
  • Fax: 620-879-2246
Mailing address:
  • Phone: 620-879-2182
  • Fax: 620-879-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24578
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-32802
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: