Provider Demographics
NPI:1174552095
Name:MCKIDDY, MYRA BESS (RN)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:BESS
Last Name:MCKIDDY
Suffix:
Gender:F
Credentials:RN
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 218
Mailing Address - Street 2:HIGHWAY # 9
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-0218
Mailing Address - Country:US
Mailing Address - Phone:405-395-9303
Mailing Address - Fax:405-395-9305
Practice Address - Street 1:2307 SOUTH GORDON COOPER DRIVE
Practice Address - Street 2:CITIZEN POTAWATOMI NATION/FIRELAKE WELLNESS CENTER
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801
Practice Address - Country:US
Practice Address - Phone:405-395-9303
Practice Address - Fax:405-395-9305
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK48859163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator