Provider Demographics
NPI:1487347050
Name:METCALF, CHRISTAN
Entity type:Individual
Prefix:
First Name:CHRISTAN
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N MAIN ST
Mailing Address - Street 2:BROKEN BOW, OK
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-3975
Mailing Address - Country:US
Mailing Address - Phone:580-584-2478
Mailing Address - Fax:
Practice Address - Street 1:205 N MAIN ST
Practice Address - Street 2:BROKEN BOW, OK
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-3975
Practice Address - Country:US
Practice Address - Phone:580-584-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist