=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568377414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROY HARRIS JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2026
-----------------------------------------------------
Last Update Date | 08/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32018 HIGHWAY 59
-----------------------------------------------------
City | MAUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74854-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-374-1225
-----------------------------------------------------
Fax | 866-201-3530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8
-----------------------------------------------------
City | MAUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74854-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-374-1225
-----------------------------------------------------
Fax | 866-201-3530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------