Healthcare Provider Details

I. General information

NPI: 1255267621
Provider Name (Legal Business Name): MRS. SAMARA R WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N WASHINGTON AVE
DURANT OK
74701-2128
US

IV. Provider business mailing address

9007 S CALLEN RD
MILBURN OK
73450-1027
US

V. Phone/Fax

Practice location:
  • Phone: 580-706-6936
  • Fax: 855-708-5544
Mailing address:
  • Phone: 580-706-6936
  • Fax: 855-708-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberA088088715
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: