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NPI Code Detail

MEDICARE: KAEGAN MARIE CULLISON PA-C

MEDICARE: KAEGAN MARIE CULLISON PA-C
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
1363A00000XPhysician Assistant5295OK

General Provider Information

NPI Number : 1912744004
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAEGAN MARIE CULLISON PA-C
Provider Business Mailing Address
First Line : 3001 QUAIL SPRINGS PKWY FL 5
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2640
Country : US
Telephone Number : 405-949-3349
Fax Number : 405-945-5467
Provider Business Practice Location Address
First Line : 3300 NW EXPRESSWAY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-4418
Country : US
Telephone Number : 405-949-3349
Fax Number : 405-945-5467
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2024
Last Update Date : 05/20/2026

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