Healthcare Provider Details

I. General information

NPI: 1871551259
Provider Name (Legal Business Name): PAMELA LYNN MCCRAY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 310
TULSA OK
74136-7805
US

IV. Provider business mailing address

PO BOX 288
ELMORE CITY OK
73433-0288
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-3000
  • Fax: 918-236-3060
Mailing address:
  • Phone: 580-788-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR 0053330
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: