Provider Demographics
NPI:1679158836
Name:HAMM, MICHAYLA RENAE
Entity type:Individual
Prefix:MS
First Name:MICHAYLA
Middle Name:RENAE
Last Name:HAMM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 S YALE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6273
Mailing Address - Country:US
Mailing Address - Phone:918-894-5115
Mailing Address - Fax:918-856-3111
Practice Address - Street 1:5314 S YALE AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6273
Practice Address - Country:US
Practice Address - Phone:918-894-5115
Practice Address - Fax:918-856-3111
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator