Provider Demographics
NPI:1538997630
Name:LUNSFORD, MIKAYLA DAWN
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:DAWN
Last Name:LUNSFORD
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 1:4808 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-5918
Mailing Address - Country:US
Mailing Address - Phone:918-814-8931
Mailing Address - Fax:
Practice Address - Street 1:4808 W 22ND ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-5918
Practice Address - Country:US
Practice Address - Phone:918-814-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator