Provider Demographics
NPI:1700655321
Name:MARCH, MAKAYLA BRIANN (PA)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:BRIANN
Last Name:MARCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:109 ESPLANADE DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-6103
Mailing Address - Country:US
Mailing Address - Phone:580-306-5446
Mailing Address - Fax:
Practice Address - Street 1:800 N PARK DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-2146
Practice Address - Country:US
Practice Address - Phone:580-584-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant