Healthcare Provider Details

I. General information

NPI: 1003635285
Provider Name (Legal Business Name): MELISSA DAWN MCRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 6TH AVE
STILLWATER OK
74074-4306
US

IV. Provider business mailing address

19800 E SIMMONS RD
LUTHER OK
73054-9527
US

V. Phone/Fax

Practice location:
  • Phone: 405-784-5842
  • Fax:
Mailing address:
  • Phone: 405-684-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220202
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: