Healthcare Provider Details

I. General information

NPI: 1437374832
Provider Name (Legal Business Name): MELINDA K BAILEY APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA K GOWER APRN-CNP

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S. MAIN STREET
AFTON OK
74331-0705
US

IV. Provider business mailing address

3200 S KINGS HWY
CUSHING OK
74023-5355
US

V. Phone/Fax

Practice location:
  • Phone: 918-257-8029
  • Fax: 918-257-8042
Mailing address:
  • Phone: 918-225-3336
  • Fax: 918-223-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0032158
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: