Healthcare Provider Details

I. General information

NPI: 1871383497
Provider Name (Legal Business Name): ANGELA LEIGH PHILPOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
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: 918-775-5526
Mailing address:
  • Phone: 918-775-5513
  • Fax: 918-775-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: