Breedlove Wound Care of Oklahoma LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

BREEDLOVE WOUND CARE OF OKLAHOMA LLC

Practice address

207 E Taliaferro St
Madill, OK 73446-3410

Phone

(903) 947-2020

NPI assigned

Jan 22, 2025

Last updated

Jan 22, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Wilson

Title

Assistant Manager Credentialing

Phone

(956) 331-2458

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leslie Orr Battles, CNP

  • Family Nurse Practitioner
  • Broken Bow, OK
  • NPI 1588204465
  Medicare reassignment NPD
• Bailey Camille Buck, DO

  • Family Medicine Physician
  • Durant, OK
  • NPI 1457978934
  Medicare reassignment NPD
• Michael Glen Cranford, DO

  • Family Medicine Physician
  • Durant, OK
  • NPI 1528553153
  Medicare reassignment NPD
• Randall Jason Davault, M.D.

  • Surgery Physician
  • Durant, OK
  • NPI 1457491904
  Medicare reassignment NPD
• Haylie Ashtyn Mata

  • Family Nurse Practitioner
  • Boswell, OK
  • NPI 1992525976
  Medicare reassignment NPD
• Jodie H Moore, APRN-CNP

  • Family Nurse Practitioner
  • Boswell, OK
  • NPI 1669031266
  Medicare reassignment NPD
• Ashley Renee Smalling, ARNP

  • Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1467860189
  Medicare reassignment NPD
• Martin A Taylor, MD

  • Family Medicine Physician
  • Onalaska, TX
  • NPI 1578535092

  OK

  Medicare reassignment NPD
• Elizabeth Ann Breedlove, FNP

  • Family Nurse Practitioner
  • Tatum, TX
  • NPI 1982844213
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1659183135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1129",
            "city": "TATUM",
            "state": "TX",
            "postal_code": "756911129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E TALIAFERRO ST",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734463410",
            "telephone_number": "903-947-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREEDLOVE WOUND CARE OF OKLAHOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ASSISTANT MANAGER CREDENTIALING",
        "authorized_official_telephone_number": "956-331-2458"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Beard
• Ollie Logan Beard III, DDS
• Kimberly Renee Bennett
• Ariel Bivens
• Patricia Gay Block
• Brief Interventions, Inc.
• Carol J Brown, BA, PSRS
• Stacy Buford, LPN, LVN
• Calvin Harkins Dba Corner Drug Store (Corner Drug Store)
• Helen Marie Clark

• Surgery Physician in Madill, OK
• Providers in Madill, OK by specialty
• Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.