Provider Demographics
NPI:1134852353
Name:MCGARRAH, STACI RASHEL
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:RASHEL
Last Name:MCGARRAH
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 1:1812 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8477
Mailing Address - Country:US
Mailing Address - Phone:469-831-1877
Mailing Address - Fax:
Practice Address - Street 1:1812 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8477
Practice Address - Country:US
Practice Address - Phone:479-831-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH082928536175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist