Healthcare Provider Details

I. General information

NPI: 1528976560
Provider Name (Legal Business Name): SKYLAR MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E REDWOOD AVE
SALLISAW OK
74955-2811
US

IV. Provider business mailing address

213 E REDWOOD AVE
SALLISAW OK
74955-2811
US

V. Phone/Fax

Practice location:
  • Phone: 918-774-1160
  • Fax: 918-776-0480
Mailing address:
  • Phone: 918-774-1160
  • Fax: 918-776-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4216
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: