Provider Demographics
NPI:1215008826
Name:SIMS, ROY WYNN (BS, BHRS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:WYNN
Last Name:SIMS
Suffix:
Gender:M
Credentials:BS, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74818-0576
Mailing Address - Country:US
Mailing Address - Phone:405-382-5946
Mailing Address - Fax:
Practice Address - Street 1:SE OF BOLEY ON HWY 62
Practice Address - Street 2:
Practice Address - City:BOLEY
Practice Address - State:OK
Practice Address - Zip Code:74829
Practice Address - Country:US
Practice Address - Phone:918-667-3633
Practice Address - Fax:918-667-3651
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK#9865171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator