Family Medicine
BLACKHAWK MANGUM, LLC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1093986937 · enumerated 2008-03-19 · record updated 2008-07-23. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: SHANA DAVENPORT, Insurance Credentialing Supervisor · (512) 681-3460
Addresses and phones
- Mailing address PO BOX 280, MANGUM, OK, 73554 Google Maps Apple Maps OpenStreetMap
- Practice location ONE WICKERSHAM DR, MANGUM, OK, 73554 (580) 782-3353 Fax (580) 782-2811 Google Maps Apple Maps OpenStreetMap
Specialties
- Emergency Medicine 207P00000X · License 2208 OK
- Physician Assistant 363A00000X · License 2208 OK
- Nurse Practitioner, Family 363LF0000X · License 2208 OK
- Family Medicine 207Q00000X · Primary · License 2208 OK
In this directory
Locations and evidence
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Practice location
MANGUM, OK, 73554
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.