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General NPI Number Information
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NPI Number | 1366250821
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Entity Type | Organization
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Legal Business Name | MEYGAN MODE APRN-CNP PLLC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 210 W ROBERT ST
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City | POTEAU
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State | OK
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Zip | 74953-2942
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Country | US
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Telephone | 918-649-0069
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Fax | 918-649-0067
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Provider Business Mailing Address
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Address Line | 21642 MCKENZIE RD
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City | POTEAU
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State | OK
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Zip | 74953-8757
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Country | US
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Telephone | 479-276-4277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEYGAN R MODE
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Credential | APRN-CNP
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Telephone | 479-276-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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