MEDICARE: RUTH LYNN MAYO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1154075281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH LYNN MAYO

Provider Business Mailing Address
First Line	:	12529 SW 14TH ST
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-7004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 BROADWAY EXT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7482
Country	:	US
Telephone Number	:	405-424-7711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	10/24/2025

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