Healthcare Provider Details

I. General information

NPI: 1164403986
Provider Name (Legal Business Name): LANA DAWN MYERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/02/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 EAST ROSS BYPASS
TAHLEQUAH OK
74464
US

IV. Provider business mailing address

1201 EAST ROSS BYPASS
TAHLEQUAH OK
74464
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-0991
  • Fax: 918-456-7570
Mailing address:
  • Phone: 918-207-0991
  • Fax: 918-456-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4231
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4231
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200046930B
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: