Healthcare Provider Details

I. General information

NPI: 1285553172
Provider Name (Legal Business Name): MACKINZIE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16336 MUIRFIELD PL
EDMOND OK
73013-9145
US

IV. Provider business mailing address

16336 MUIRFIELD PL
EDMOND OK
73013-9145
US

V. Phone/Fax

Practice location:
  • Phone: 405-406-4136
  • Fax: 405-562-5037
Mailing address:
  • Phone: 405-406-4136
  • Fax: 405-562-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-546182
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: