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NPI Code Detail

MEDICARE: MISS TERA L MCCULLAR BA

MEDICARE: MISS TERA L MCCULLAR BA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1528263399
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TERA L MCCULLAR BA
Provider Business Mailing Address
First Line : PO BOX 524
Second Line :
City : ROFF
State : OK
Zip : 74865-0524
Country : US
Telephone Number : 580-399-3699
Fax Number : 580-421-3150
Provider Business Practice Location Address
First Line : 1308 CRADDUCK RD
Second Line :
City : ADA
State : OK
Zip : 74820-8442
Country : US
Telephone Number : 580-332-3699
Fax Number : 580-421-9828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 10/18/2010

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Directions to “ MISS TERA L MCCULLAR BA” Practice Location

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