Healthcare Provider Details

I. General information

NPI: 1942357215
Provider Name (Legal Business Name): MARY KATHRYN MACHADO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHRYN MASON ARNP

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W 1ST ST
WEWOKA OK
74884-2103
US

IV. Provider business mailing address

PO BOX 236
WETUMKA OK
74883-0236
US

V. Phone/Fax

Practice location:
  • Phone: 405-257-5422
  • Fax: 405-257-5463
Mailing address:
  • Phone: 405-257-5422
  • Fax: 405-257-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0073365
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: