Provider Demographics
NPI:1306647110
Name:ROBERTS SCOGGINS, MICHELLE KAYE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:KAYE
Last Name:ROBERTS SCOGGINS
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 1:117 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-7203
Mailing Address - Country:US
Mailing Address - Phone:918-323-5064
Mailing Address - Fax:
Practice Address - Street 1:117 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7203
Practice Address - Country:US
Practice Address - Phone:918-323-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist