Provider Demographics
NPI:1720968597
Name:MCMAHON, TALIA
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 MIRANDA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-9738
Mailing Address - Country:US
Mailing Address - Phone:405-588-9511
Mailing Address - Fax:
Practice Address - Street 1:425 S FRETZ AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5532
Practice Address - Country:US
Practice Address - Phone:405-757-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician