Healthcare Provider Details

I. General information

NPI: 1063364115
Provider Name (Legal Business Name): CY CALLAN FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N COUNTRY CLUB RD
ADA OK
74820-2847
US

IV. Provider business mailing address

521 WEBB AVE
ADA OK
74820-4637
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229716
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: