Healthcare Provider Details

I. General information

NPI: 1053275164
Provider Name (Legal Business Name): MELODY C BYRD RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 MEDICAL CENTER DRIVE
KINGFISHER OK
73750
US

IV. Provider business mailing address

PO BOX 29
KINGFISHER OK
73750-0029
US

V. Phone/Fax

Practice location:
  • Phone: 580-922-1107
  • Fax:
Mailing address:
  • Phone: 580-922-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4708
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: