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General NPI Number Information
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NPI Number | 1013884386
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Entity Type | Individual
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Provider Name | MARQUANA FOURKILLER LPN
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Gender | Female
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 704 S 2ND ST
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City | STILWELL
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State | OK
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Zip | 74960-4820
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Country | US
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Telephone | 918-410-0079
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 W KEETOOWAH ST
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3497
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Country | US
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Telephone | 918-708-9009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 216331
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License Number State | OK
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