Healthcare Provider Details

I. General information

NPI: 1376945857
Provider Name (Legal Business Name): MRS. SHEILA K MEDLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980547 S STAGECOACH DR
WELLSTON OK
74881-8225
US

IV. Provider business mailing address

980547 S STAGECOACH
WELLSTON OKLAHOMA
74881
UM

V. Phone/Fax

Practice location:
  • Phone: 405-820-6313
  • Fax:
Mailing address:
  • Phone: 405-820-6313
  • Fax:

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: