Healthcare Provider Details

I. General information

NPI: 1124459177
Provider Name (Legal Business Name): JOHN MCKAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5108
US

IV. Provider business mailing address

4400 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5108
US

V. Phone/Fax

Practice location:
  • Phone: 405-425-0439
  • Fax: 812-471-6650
Mailing address:
  • Phone: 405-424-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001525A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: