Most Relevant Information
Provider Data
| NPI Number: | 1003542168 |
| Provider Name: | SAMANTHA LYNN MCCULLOUGH FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | R0124315 |
Most Important Dates
| Enumeration Date: | 07/29/2022 |
| Last Updated: | 07/29/2022 |
Provider Practice Location
10728 N 152ND EAST AVE
OWASSO
OK
740556384
Practice Location Phone/Fax
| Phone: | 9189140675 |
| Fax: |
Provider Mailing Location
10728 N 152ND EAST AVE
OWASSO
OK
740556384
Provider Mailing Phone/Fax
| Phone: | 9189140675 |
| Fax: |