Healthcare Provider Details

I. General information

NPI: 1508596420
Provider Name (Legal Business Name): CIMARRON CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OK-33
PERKINS OK
74059-7405
US

IV. Provider business mailing address

PO BOX 555
WILBURTON OK
74578-0555
US

V. Phone/Fax

Practice location:
  • Phone: 405-547-1171
  • Fax: 405-547-4075
Mailing address:
  • Phone: 405-547-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASMINE BOYD
Title or Position: PROVIDER/MANAGER
Credential: APRN, FNP
Phone: 405-547-1171