Active NPI 1427031863 Individual Practitioner Male Practitioner

Dr. Bryan M Sheehan , DPM

Podiatrist • Grove, OK

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Bryan Sheehan, DPM is a certified Podiatrist practicing in Grove, OK. With approximately 31 years of clinical experience since graduating from Temple University School Of Podiatric Medicine in 1995, Dr. Sheehan delivers high-quality medical care to the local community at 1200 NEO LOOP.

Dr. Sheehan accepts Medicare assignment.

Frequently performed procedures and clinical services include removal of fingernails or toenails, established patient outpatient office visit, ultrasound study of arm and leg arteries. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1200 Neo Loop
Ste A

Grove, OK 74344

Telephone 9187876893

Fax 9187876815

Associated Practice Facility / Clinic

🏢 Ankle & Foot Centers Of Mid-America Facility NPI 1669694170

Medicare Profile & Education

Medical School

Temple University School Of Podiatric Medicine

Graduation Year

1995

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Podiatrist in Grove, OK

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

31 Yrs +11.5 yrs vs City Avg

City Avg: 19.5 Yrs

State Avg: 26.8 Yrs

Regional Practice Density

2 Specialists

Practicing in Grove, OK (71 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

29.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Sheehan (31 Years) 31 Yrs

Grove Specialty Average (19.5 Years) 19.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11721 Removal of fingernails or toenails, 6 or more nails	667	281	$49.03	$42.01
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	532	245	$142.57	$121.93
93922 Ultrasound study of arm and leg arteries	410	324	$86.94	$74.47
73630 X-ray of foot, minimum of 3 views	328	164	$36.58	$31.15
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	311	79	$1.20	$0.98
99213 Established patient office or other outpatient visit, typically 15 minutes	297	187	$100.72	$86.38
11056 Removal of noncancer thickened skin growth, 2-4 growths	168	112	$88.55	$73.91
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	138	138	$185.96	$159.27
11055 Removal of single thickened skin growth	113	90	$75.98	$63.69
20550 Injection into tendon or ligament	62	45	$65.73	$44.47
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	46	44	$25.56	$21.96
20600 Aspiration and/or injection of fluid from small joint	38	28	$61.25	$45.14
11042 Removal of skin and tissue, 20.0 sq cm or less	38	13	$141.12	$116.35
97597 Removal of tissue from wound, 20.0 sq cm or less	34	18	$109.43	$93.95
20605 Aspiration and/or injection of medium joint or joint capsule	34	13	$76.54	$50.45
11750 Permanent removal fingernail or toenail	29	27	$175.17	$147.65
28234 Incision to release foot tendon	25	17	$442.53	$234.92
11057 Removal of noncancer thickened skin growth, more than 4 growths	25	17	$97.51	$83.55
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	24	24	$123.59	$105.87
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	21	20	$62.24	$53.08
28232 Incision to lengthen toe tendon	21	12	$407.83	$208.84
29540 Placement of strapping to ankle or foot	20	17	$31.00	$16.00
28270 Incision of joint capsule of foot and toe	13	11	$527.33	$326.09

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11721 Removal of fingernails or toenails, 6 or more nails	659	296	$57.11	$41.11
99213 Established patient office or other outpatient visit, typically 15 minutes	565	287	$106.29	$84.08
73630 X-ray of foot, minimum of 3 views	377	191	$60.58	$30.92
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	304	80	$4.15	$1.07
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	294	179	$138.16	$119.30
93922 Ultrasound study of arm and leg arteries	292	290	$139.72	$73.12
11056 Removal of noncancer thickened skin growth, 2-4 growths	127	96	$94.84	$74.07
20550 Injection into tendon or ligament	121	77	$85.60	$46.42
11055 Removal of single thickened skin growth	112	99	$78.53	$63.15
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	111	111	$150.09	$102.79
28232 Incision to lengthen toe tendon	67	36	$412.73	$216.83
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	56	56	$125.00	$89.53
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	55	55	$192.75	$155.24
28234 Incision to release foot tendon	43	29	$423.98	$232.06
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	36	36	$175.00	$134.74
28270 Incision of joint capsule of foot and toe	33	21	$484.43	$327.17
11000 Removal of inflamed or infected skin, up to 10% of body surface	28	17	$74.21	$41.14
11750 Permanent removal fingernail or toenail	28	24	$276.01	$147.61
11042 Removal of skin and tissue, 20.0 sq cm or less	26	12	$152.87	$92.57
11057 Removal of noncancer thickened skin growth, more than 4 growths	19	13	$112.73	$81.82
76000 Imaging guidance for procedure, 60 minutes or less	18	17	$121.36	$39.25
29540 Placement of strapping to ankle or foot	17	14	$53.27	$15.38
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	16	16	$62.32	$52.16
11720 Removal of fingernails or toenails, 1-5 nails	14	11	$35.38	$30.03

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11721 Removal of fingernails or toenails, 6 or more nails	699	317	$63.00	$41.05
99213 Established patient office or other outpatient visit, typically 15 minutes	638	330	$110.00	$84.51
93922 Ultrasound study of arm and leg arteries	473	400	$150.00	$73.62
73630 X-ray of foot, minimum of 3 views	472	243	$75.00	$31.07
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	412	105	$6.00	$1.15
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	353	202	$135.00	$119.73
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	279	174	$125.00	$88.54
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	191	116	$175.00	$127.85
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	181	181	$156.00	$103.25
20550 Injection into tendon or ligament	173	108	$93.00	$44.41
11750 Permanent removal fingernail or toenail	84	62	$350.00	$134.45
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	66	39	$185.00	$164.14
11000 Removal of inflamed or infected skin, up to 10% of body surface	64	23	$75.00	$41.39
28234 Incision to release foot tendon	52	28	$416.00	$232.06
28232 Incision to lengthen toe tendon	50	24	$416.00	$221.34
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	39	39	$224.03	$155.66
28270 Incision of joint capsule of foot and toe	38	22	$475.00	$345.86
11042 Removal of skin and tissue, 20.0 sq cm or less	37	13	$167.00	$115.13
11720 Removal of fingernails or toenails, 1-5 nails	29	19	$35.00	$29.67
29540 Placement of strapping to ankle or foot	28	21	$60.36	$16.15
28124 Partial removal of toe bone	17	11	$700.00	$282.00
76000 Imaging guidance for procedure, 60 minutes or less	15	15	$150.00	$39.06

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4197 Puraply xt, per square centimeter	2,591	19	$398.15	$264.45
Q4159 Affinity, per square centimeter	693	15	$1200.00	$961.71
11721 Removal of fingernails or toenails, 6 or more nails	670	332	$63.00	$41.90
99213 Established patient office or other outpatient visit, typically 15 minutes	515	285	$110.00	$86.11
73630 X-ray of foot, minimum of 3 views	441	217	$75.00	$31.06
93922 Ultrasound study of arm and leg arteries	419	355	$150.00	$77.07
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	402	203	$135.00	$122.84
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	344	104	$6.03	$1.23
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	254	167	$125.00	$87.17
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	186	120	$175.00	$132.82
20550 Injection into tendon or ligament	171	103	$93.00	$41.57
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	167	167	$156.00	$105.72
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	158	22	$303.64	$145.10
11042 Removal of skin and tissue, 20.0 sq cm or less	94	27	$167.00	$77.18
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	66	44	$185.00	$160.45
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	40	20	$36.00	$21.07
11750 Permanent removal fingernail or toenail	38	33	$350.00	$143.54
28232 Incision to lengthen toe tendon	36	21	$416.00	$219.60
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	27	27	$224.00	$154.74
29540 Placement of strapping to ankle or foot	27	21	$60.00	$13.74
28234 Incision to release foot tendon	26	17	$416.00	$259.79
11720 Removal of fingernails or toenails, 1-5 nails	23	16	$35.00	$30.95
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	22	19	$500.00	$333.78
11000 Removal of inflamed or infected skin, up to 10% of body surface	20	12	$75.00	$38.05

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4159 Affinity, per square centimeter	1,645	19	$1084.47	$975.98
Q4197 Puraply xt, per square centimeter	1,175	17	$404.26	$257.41
11721 Removal of fingernails or toenails, 6 or more nails	711	360	$63.00	$43.30
99213 Established patient office or other outpatient visit, typically 15 minutes	649	350	$110.00	$71.29
73630 X-ray of foot, minimum of 3 views	446	227	$75.17	$29.65
93922 Ultrasound study of arm and leg arteries	419	359	$150.00	$77.12
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	409	217	$135.00	$103.60
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	333	96	$6.09	$1.45
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	306	204	$125.00	$92.67
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	188	119	$168.24	$134.11
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	172	172	$156.00	$101.97
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	170	31	$300.00	$140.03
20550 Injection into tendon or ligament	166	100	$93.00	$41.77
11042 Removal of skin and tissue, 20.0 sq cm or less	90	34	$167.00	$69.69
11000 Removal of inflamed or infected skin, up to 10% of body surface	62	34	$75.00	$39.63
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	58	38	$181.98	$152.01
28232 Incision to lengthen toe tendon	53	25	$416.00	$203.28
11750 Permanent removal fingernail or toenail	48	42	$350.00	$143.63
11102 Tangential biopsy of single skin lesion	38	22	$132.00	$65.43
28234 Incision to release foot tendon	36	22	$416.94	$231.53
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	34	22	$36.00	$21.68
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	32	30	$485.16	$333.80
28270 Incision of joint capsule of foot and toe	31	21	$401.61	$303.17
28124 Partial removal of toe bone	30	21	$700.00	$312.36
29540 Placement of strapping to ankle or foot	24	18	$60.00	$14.33
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	24	11	$369.00	$220.10
76000 Imaging guidance for procedure, 60 minutes or less	23	21	$150.00	$38.48
11720 Removal of fingernails or toenails, 1-5 nails	19	16	$35.00	$30.86
11423 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	17	12	$250.00	$177.51

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11721 Removal of fingernails or toenails, 6 or more nails	843	439	$63.00	$43.23
99213 Established patient office or other outpatient visit, typically 15 minutes	840	440	$110.00	$70.11
73630 X-ray of foot, minimum of 3 views	632	308	$75.00	$28.53
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	420	122	$6.09	$1.59
93922 Ultrasound study of arm and leg arteries	362	334	$150.00	$78.53
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	352	224	$135.00	$103.55
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	313	228	$125.00	$90.61
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	269	269	$156.00	$102.03
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	217	145	$150.00	$125.32
20550 Injection into tendon or ligament	195	119	$93.95	$43.13
11750 Permanent removal fingernail or toenail	84	70	$350.00	$137.77
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	81	52	$175.00	$147.85
11042 Removal of skin and tissue, 20.0 sq cm or less	69	22	$167.00	$92.59
11000 Removal of inflamed or infected skin, up to 10% of body surface	64	37	$75.00	$39.88
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	51	39	$36.00	$21.16
28234 Incision to release foot tendon	37	30	$416.00	$231.57
28232 Incision to lengthen toe tendon	31	23	$422.58	$201.78
29540 Placement of strapping to ankle or foot	28	20	$60.00	$16.22
11102 Tangential biopsy of single skin lesion	27	19	$132.00	$54.73
28124 Partial removal of toe bone	27	23	$700.00	$324.89
11423 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	25	20	$250.00	$160.71
11720 Removal of fingernails or toenails, 1-5 nails	22	17	$35.00	$31.33
76000 Imaging guidance for procedure, 60 minutes or less	20	18	$150.00	$43.43
28270 Incision of joint capsule of foot and toe	19	16	$478.95	$293.34
28285 Correction of toe joint deformity	15	14	$676.60	$481.14
97597 Removal of tissue from wound, 20.0 sq cm or less	14	12	$75.00	$74.91
11730 Simple separation of fingernail or toenail from nail bed, first nail	11	11	$109.00	$74.87

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	859	441	$101.97	$68.37
11721 Removal of fingernails or toenails, 6 or more nails	799	407	$63.00	$42.61
Q4159 Affinity, per square centimeter	784	24	$649.94	$634.15
73630 X-ray of foot, minimum of 3 views	647	319	$75.12	$26.64
93922 Ultrasound study of arm and leg arteries	474	416	$150.00	$79.57
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	462	131	$6.10	$1.79
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	394	245	$125.00	$81.39
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	359	232	$135.00	$101.55
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	279	279	$156.00	$101.19
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	263	164	$150.00	$115.34
20550 Injection into tendon or ligament	214	131	$93.00	$40.97
Q4160 Nushield, per square centimeter	169	13	$470.41	$196.77
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	138	27	$302.50	$130.24
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	132	86	$175.00	$144.70
11042 Removal of skin and tissue, 20.0 sq cm or less	92	39	$167.00	$81.04
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	88	52	$36.00	$19.95
11750 Permanent removal fingernail or toenail	88	76	$350.00	$139.16
11000 Removal of inflamed or infected skin, up to 10% of body surface	76	51	$75.00	$35.80
28234 Incision to release foot tendon	54	26	$430.65	$281.69
28232 Incision to lengthen toe tendon	52	35	$416.00	$230.86
11423 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	43	27	$250.00	$152.77
29540 Placement of strapping to ankle or foot	29	20	$60.52	$13.78
97597 Removal of tissue from wound, 20.0 sq cm or less	21	11	$75.00	$73.89
11720 Removal of fingernails or toenails, 1-5 nails	20	20	$35.00	$30.75
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	18	18	$497.22	$326.38
29580 Strapping, unna boot	14	12	$88.00	$48.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	915	415	$90.05	$65.52
11721 Removal of fingernails or toenails, 6 or more nails	825	385	$63.00	$40.19
73630 X-ray of foot, minimum of 3 views	453	232	$75.00	$25.18
11420 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	451	238	$124.72	$75.39
93922 Ultrasound study of arm and leg arteries	404	329	$149.88	$75.86
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	297	188	$135.00	$96.86
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	294	82	$6.04	$1.79
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	261	159	$149.90	$110.61
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	203	203	$156.00	$97.23
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	156	95	$175.00	$139.99
20550 Injection into tendon or ligament	142	81	$93.00	$40.73
11000 Removal of inflamed or infected skin, up to 10% of body surface	67	43	$75.00	$34.36
11042 Removal of skin and tissue, 20.0 sq cm or less	53	32	$167.00	$81.85
11423 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	46	30	$250.00	$161.01
11750 Permanent removal fingernail or toenail	45	41	$350.00	$130.29
11720 Removal of fingernails or toenails, 1-5 nails	41	34	$35.00	$28.42
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	29	25	$150.00	$54.08
29540 Placement of strapping to ankle or foot	16	14	$60.00	$14.48
11730 Simple separation of fingernail or toenail from nail bed, first nail	11	11	$109.00	$88.63
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	11	11	$36.00	$17.98

Medical Specialties & State Licenses

CMS Verified: 2025-08-21

Podiatrist Primary Specialty

NUCC Taxonomy Code: 213E00000X

State License OK 207

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Podiatrist

NUCC Taxonomy Code: 213E00000X

State License AR 234

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

158947717 (AR)

Medicaid State Provider ID

100779640A (OK)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Louis Pridgeon , RPT

Physical Therapist

NPI 1205817897

Registered Physical Therapist

Dr. Douglas Cox , MD

Emergency Medicine

NPI 1578543153

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active August 06, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location August 06, 2010

Registered at 1200 NEO LOOP, STE A, GROVE, OK 74344 (Tel: 9187876893)

📍

Updated Business Mailing Address August 06, 2010

Registered at PO BOX 452327, GROVE, OK 743452327 (Tel: 9187876893)

👤

Provider Name / Credentials Updated August 06, 2010

Recorded as BRYAN SHEEHAN, DPM

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 06, 2010

Podiatrist (License #207 in OK)

🟢

Initial NPI Registration & Enumeration November 21, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1427031863

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: November 21, 2005

Last Update: August 21, 2025

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

Po Box 452327

Grove, OK 743452327

Phone: 9187876893

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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