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Individual

WILLIAM A MCCULLOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C, MCMSC

Contact information

Practice address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
(580) 925-9149
Mailing address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
(580) 925-9149

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01493
KS
363A00000X
Physician Assistant
Primary
2144
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
15-01493
STATE OF KANSAS LICENSE
KS
Enumeration date
11/08/2011
Last updated
04/02/2015
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