Healthcare Provider Details

I. General information

NPI: 1366015927
Provider Name (Legal Business Name): MAKENZIE RAY MAGBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 W UNIVERSITY BLVD STE 100
DURANT OK
74701-2970
US

IV. Provider business mailing address

622 BRYAN DR
DURANT OK
74701-3462
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-7331
  • Fax: 580-924-7332
Mailing address:
  • Phone: 580-920-0909
  • Fax: 580-931-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: