Healthcare Provider Details

I. General information

NPI: 1487595351
Provider Name (Legal Business Name): WILSON FAMILY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W 5TH ST
OKMULGEE OK
74447-7301
US

IV. Provider business mailing address

112 W 5TH ST
OKMULGEE OK
74447-7301
US

V. Phone/Fax

Practice location:
  • Phone: 918-752-1080
  • Fax: 918-752-1081
Mailing address:
  • Phone: 918-752-1080
  • Fax: 918-752-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGAN BREFFNEY WILSON
Title or Position: DO
Credential:
Phone: 918-752-1080