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NPI Code Detail

MEDICARE: MICHALLA FREEMAN PRSS, CMII

MEDICARE: MICHALLA FREEMAN PRSS, CMII
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist132840OK
2171M00000XCase Manager/Care Coordinator319929OK

General Provider Information

NPI Number : 1174279061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHALLA FREEMAN PRSS, CMII
Provider Business Mailing Address
First Line : 2325 S HARVARD AVE
Second Line :
City : TULSA
State : OK
Zip : 74114-3301
Country : US
Telephone Number : 417-818-4821
Fax Number :
Provider Business Practice Location Address
First Line : 2325 S HARVARD AVE
Second Line :
City : TULSA
State : OK
Zip : 74114-3301
Country : US
Telephone Number : 417-818-4821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2022
Last Update Date : 06/16/2026

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