Healthcare Provider Details

I. General information

NPI: 1487574539
Provider Name (Legal Business Name): AESTHETIC ARTISTRY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S RANDALL AVE STE A
ELK CITY OK
73644-6202
US

IV. Provider business mailing address

900 S RANDALL AVE STE A
ELK CITY OK
73644-6202
US

V. Phone/Fax

Practice location:
  • Phone: 580-799-1690
  • Fax: 580-942-2256
Mailing address:
  • Phone: 580-799-1690
  • Fax: 580-942-2256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SIMMONS
Title or Position: OWNER
Credential: APRN
Phone: 580-799-1690