Provider Demographics
NPI:1679535181
Name:HORAN, MICHELLE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARY
Last Name:HORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:MARY
Other - Last Name:KINGSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:ER DEPT.
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-5011
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8521207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100072720AMedicaid
AR124674001Medicaid
AR124674001Medicaid
AR0100550202Medicare PIN
OK100072720AMedicaid