Healthcare Provider Details

I. General information

NPI: 1164360962
Provider Name (Legal Business Name): AMY JIM RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

9553 S 13TH ST E
MUSKOGEE OK
74403-6534
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3309
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: