Basic Information
| Provider Information | |||||||||
| NPI: | 1013283209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | BREFFNEY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 112 WEST 5TH STREET | ||||||||
| Address2: | |||||||||
| City: | OKMULGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744475320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187521080 | ||||||||
| FaxNumber: | 9187521081 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 WEST 5TH STREET | ||||||||
| Address2: | |||||||||
| City: | OKMULGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187521080 | ||||||||
| FaxNumber: | 9187521081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2012 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5468 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.