Healthcare Provider Details

I. General information

NPI: 1053850693
Provider Name (Legal Business Name): MELISSA PERRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24797 S HIGHWAY 66 UNIT 5
CLAREMORE OK
74019-2402
US

IV. Provider business mailing address

24797 S HIGHWAY 66 UNIT 5
CLAREMORE OK
74019-2402
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-2080
  • Fax: 918-342-0075
Mailing address:
  • Phone: 918-342-2080
  • Fax: 918-342-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: