Provider Demographics
NPI:1942357215
Name:MACHADO, MARY KATHRYN (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:MACHADO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-0236
Mailing Address - Country:US
Mailing Address - Phone:405-257-5422
Mailing Address - Fax:405-257-5463
Practice Address - Street 1:207 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-2103
Practice Address - Country:US
Practice Address - Phone:405-257-5422
Practice Address - Fax:405-257-5463
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily