=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942357215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY KATHRYN MACHADO ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 W 1ST ST
-----------------------------------------------------
City | WEWOKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74884-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-257-5422
-----------------------------------------------------
Fax | 405-257-5463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 236
-----------------------------------------------------
City | WETUMKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74883-0236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-257-5422
-----------------------------------------------------
Fax | 405-257-5463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R0073365
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------