Healthcare Provider Details

I. General information

NPI: 1245830439
Provider Name (Legal Business Name): MIKAYLA NEAL MEFFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 W GORE BLVD STE A2
LAWTON OK
73505-5977
US

IV. Provider business mailing address

416 N MAIN ST
ALTUS OK
73521-3108
US

V. Phone/Fax

Practice location:
  • Phone: 580-699-8383
  • Fax:
Mailing address:
  • Phone: 580-379-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: