Healthcare Provider Details

I. General information

NPI: 1376358853
Provider Name (Legal Business Name): MELISSA DIANE MILLS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA DIANE TAYLOR

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 N WHEELER AVE
SALLISAW OK
74955-2227
US

IV. Provider business mailing address

1108 N WHEELER AVE
SALLISAW OK
74955-2227
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-5513
  • Fax:
Mailing address:
  • Phone: 918-775-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR0093137
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: