Provider Demographics
NPI:1932875184
Name:EARLES, MEGAN WISENBAUGH (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:WISENBAUGH
Last Name:EARLES
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:WISENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:PO BOX 5033
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5033
Mailing Address - Country:US
Mailing Address - Phone:800-781-1220
Mailing Address - Fax:
Practice Address - Street 1:13100 N WESTERN AVE STE 303
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1432
Practice Address - Country:US
Practice Address - Phone:800-781-1220
Practice Address - Fax:888-678-8616
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily