Healthcare Provider Details

I. General information

NPI: 1730878158
Provider Name (Legal Business Name): MAKAYLA HUBBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37163 MARTIN RD
WISTER OK
74966-2701
US

IV. Provider business mailing address

301 MAGNOLIA AVE
WISTER OK
74966-2906
US

V. Phone/Fax

Practice location:
  • Phone: 918-839-1364
  • Fax:
Mailing address:
  • Phone: 918-839-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number000000000
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0000000000
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: