Individual
MRS. MEGAN ELIZABETH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, C-NP
Contact information
Practice address
110 W 1ST ST, BROKEN BOW, OK 74728
(580) 584-3099
(580) 584-3097
Mailing address
110 W 1ST ST, BROKEN BOW, OK 74728-3902
(580) 584-3099
(844) 716-2493
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
100330
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200636630A
—
OK
Enumeration date
02/10/2016
Last updated
08/07/2018
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