Healthcare Provider Details

I. General information

NPI: 1932405099
Provider Name (Legal Business Name): MELISSA K MCCARTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 N THOMPKINS AVE
BETHANY OK
73008-5307
US

IV. Provider business mailing address

14101 N EASTERN AVE STE C
EDMOND OK
73013-5860
US

V. Phone/Fax

Practice location:
  • Phone: 405-495-6134
  • Fax:
Mailing address:
  • Phone: 405-271-1515
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: