Healthcare Provider Details

I. General information

NPI: 1942178264
Provider Name (Legal Business Name): MELISSA HARRIS MEDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S WILSON ST
POTEAU OK
74953-4917
US

IV. Provider business mailing address

40097 S HIGHWAY 26 APT B
KEOTA OK
74941-6843
US

V. Phone/Fax

Practice location:
  • Phone: 918-649-0011
  • Fax: 918-649-0066
Mailing address:
  • Phone: 918-776-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number410259
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: