Healthcare Provider Details

I. General information

NPI: 1114059573
Provider Name (Legal Business Name): MANNFORD PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVANS AND GREENWOOD ST
MANNFORD OK
74044
US

IV. Provider business mailing address

PO BOX 100
MANNFORD OK
74044
US

V. Phone/Fax

Practice location:
  • Phone: 918-864-4062
  • Fax:
Mailing address:
  • Phone: 918-864-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberROO49975
License Number StateOK

VIII. Authorized Official

Name: MS. LISA JILL MCKINNEY
Title or Position: SCHOOL NURSE
Credential: RN
Phone: 918-865-4062