Provider Demographics
NPI:1700877586
Name:MCQUEEN, PAULA KAY (DO)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:502 RANSTEN ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4185
Mailing Address - Country:US
Mailing Address - Phone:918-431-1614
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:WILMA P. MANKILLER HEALTH CENTER
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG64667Medicare UPIN