Individual
MELISSA BLACKBIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
499 W BOUNDRY, KANSAS, OK 74347-1662
(918) 868-2567
(918) 868-5584
Mailing address
PO BOX 196, 207 W MAIN, KANSAS, OK 74347-0196
(918) 868-2567
(918) 868-5584
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
48776
OK
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Enumeration date
12/10/2015
Last updated
12/10/2015
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