Provider Demographics
NPI:1639781024
Name:MCMAHAN, AMBER NICOLE (MED)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S WILSON ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4917
Mailing Address - Country:US
Mailing Address - Phone:918-261-9130
Mailing Address - Fax:
Practice Address - Street 1:210 S WILSON ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4917
Practice Address - Country:US
Practice Address - Phone:918-261-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator