Provider Demographics
NPI:1710566088
Name:SCHULTZ, MAKENNA (DO)
Entity type:Individual
Prefix:DR
First Name:MAKENNA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MAKENNA
Other - Middle Name:
Other - Last Name:RICKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8558
Mailing Address - Country:US
Mailing Address - Phone:405-757-3742
Mailing Address - Fax:405-757-3744
Practice Address - Street 1:2017 W I 35 FRONTAGE RD STE 170
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-757-3742
Practice Address - Fax:405-757-3744
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207487207Q00000X
OK8440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine