Individual
MALLORY TAGGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP, AGPCNP-BC
Contact information
Practice address
401 SW 80TH ST, BUILDING D, SUITE 200, OKLAHOMA CITY, OK 73139-8122
(405) 601-4227
Mailing address
401 SW 80TH ST, BLDG D, STE. 200, OKLAHOMA CITY, OK 73139-8122
(405) 601-4227
(405) 601-4237
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
99510
OK
Other
Enumeration date
08/17/2015
Last updated
02/04/2016
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