Individual
SAMANTHA LYNN MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
10728 N 152ND EAST AVE, OWASSO, OK 74055-6384
(918) 914-0675
Mailing address
10728 N 152ND EAST AVE, OWASSO, OK 74055-6384
(918) 914-0675
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0124315
OK
363LF0000X
Family Nurse Practitioner
Primary
209493
OK
Other
Enumeration date
07/29/2022
Last updated
07/29/2022
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