Healthcare Provider Details

I. General information

NPI: 1740104090
Provider Name (Legal Business Name): EMMA JEAN NUNLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 STATE HIGHWAY 17 STE F
ELGIN OK
73538-4521
US

IV. Provider business mailing address

9201 STATE HIGHWAY 17 STE F
ELGIN OK
73538-4521
US

V. Phone/Fax

Practice location:
  • Phone: 580-454-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4212
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: