Healthcare Provider Details

I. General information

NPI: 1255929436
Provider Name (Legal Business Name): BRANDY MCCALIP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 GRANT BLVD
YUKON OK
73099-0037
US

IV. Provider business mailing address

20833 STATE HIGHWAY 24
PURCELL OK
73080-4629
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-4660
  • Fax: 405-470-3377
Mailing address:
  • Phone: 405-401-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200236
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: