Provider Demographics
NPI:1427048057
Name:HALCOMB, MONICA L (ARNP MS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:HALCOMB
Suffix:
Gender:F
Credentials:ARNP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S CASTLEROCK LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4584
Mailing Address - Country:US
Mailing Address - Phone:405-256-6000
Mailing Address - Fax:405-256-6001
Practice Address - Street 1:200 S CASTLEROCK LN
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4584
Practice Address - Country:US
Practice Address - Phone:405-256-6000
Practice Address - Fax:405-256-6001
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ58260Medicare UPIN