Provider Demographics
NPI:1437739182
Name:CALLIHAN, CALLIE NOELL (LPN)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:NOELL
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-1538
Mailing Address - Country:US
Mailing Address - Phone:918-801-6880
Mailing Address - Fax:
Practice Address - Street 1:1015 W WASHBOURNE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-4205
Practice Address - Country:US
Practice Address - Phone:844-458-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2023-11-27
Deactivation Date:2023-10-30
Deactivation Code:
Reactivation Date:2023-11-08
Provider Licenses
StateLicense IDTaxonomies
OK212393164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse