Provider Demographics
NPI:1013229509
Name:MCCRACKEN, RACHAEL LEE (DO)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WYANDOTTE AVE.
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:OK
Mailing Address - Zip Code:74061-0000
Mailing Address - Country:US
Mailing Address - Phone:918-536-2104
Mailing Address - Fax:
Practice Address - Street 1:400 WYANDOTTE AVE.
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:OK
Practice Address - Zip Code:74061-0000
Practice Address - Country:US
Practice Address - Phone:918-536-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6965207P00000X, 207Q00000X
OK4927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine