Healthcare Provider Details

I. General information

NPI: 1063846699
Provider Name (Legal Business Name): AKY MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N EASTERN AVE
MOORE OK
73160-5833
US

IV. Provider business mailing address

PO BOX 891625
OKLAHOMA CITY OK
73189-1625
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax: 405-703-0645
Mailing address:
  • Phone: 405-757-7818
  • Fax: 888-673-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLEY HENTHORN
Title or Position: CREDENTIALING
Credential:
Phone: 52-373-7704