Healthcare Provider Details

I. General information

NPI: 1821377334
Provider Name (Legal Business Name): PHYLLIS YVONNE GECKLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 HIGHWAY 70 E
MEAD OK
73449
US

IV. Provider business mailing address

1381 SAWMILL RD
DURANT OK
74701-1008
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9083
  • Fax: 580-745-9885
Mailing address:
  • Phone: 580-920-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number24021
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: