Healthcare Provider Details

I. General information

NPI: 1710779251
Provider Name (Legal Business Name): BILLY JOE SIMMONS JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10159 E 11TH ST STE 100
TULSA OK
74128-3046
US

IV. Provider business mailing address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

V. Phone/Fax

Practice location:
  • Phone: 918-351-8431
  • Fax:
Mailing address:
  • Phone: 918-577-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR0100091
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: