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General NPI Number Information
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NPI Number | 1174767255
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Entity Type | Individual
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Provider Name | MONIQUE TISHA MODEST-MCKOY M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3400 E FRANK PHILLIPS BLVD STE 400
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City | BARTLESVILLE
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State | OK
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Zip | 74006-2440
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Country | US
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Telephone | 183-312-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 1923 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-403-7066
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Fax | 918-744-2946
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 29720
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License Number State | OK
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