=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114882891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN BREANN ST. JOHN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2025
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 SW 30TH CT
-----------------------------------------------------
City | MOORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73160-2887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-676-8470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 NE 25TH ST
-----------------------------------------------------
City | BLANCHARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73010-7567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-676-8470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 210222
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------