NPI 1255165189

Taylor Montana Wallace

Practitioner Case Manager/Care Coordinator Tishomingo, OK

Practice location

Address: 602 E 24th St, Tishomingo, OK 73460-3245
Phone: (316) 312-2085
Mailing address: 36636 County Road 1700, Stonewall, OK 74871-1200

Registered specialties

Case Manager/Care Coordinator Primary

Other Service Providers Taxonomy 171M00000X

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Registry record

NPI: 1255165189
Entity type: Individual
Sex (as registered): Female
NPI issued: 2 Sep 2024
Record last updated: 2 Sep 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.