=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508596420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIMARRON CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2022
-----------------------------------------------------
Last Update Date | 06/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 OK-33
-----------------------------------------------------
City | PERKINS
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74059-7405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-547-1171
-----------------------------------------------------
Fax | 405-547-4075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 555
-----------------------------------------------------
City | WILBURTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74578-0555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-547-1171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/MANAGER
-----------------------------------------------------
Name | JASMINE BOYD
-----------------------------------------------------
Credential | APRN, FNP
-----------------------------------------------------
Telephone | 405-547-1171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------