Individual provider Active NPI

McKenzie Martin

  • Gerontology Nurse Practitioner
  • Lawton, OK
National Provider Identifier
1144088048
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
219833 Issued in OK
Practice address
104 NW 31St St
Lawton, OK 73505-6100
Phone
(805) 362-1215
NPI assigned
Mar 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 219833 OK Primary

Addresses

Primary practice location

104 NW 31St St
Lawton, OK 73505-6100

Mailing address

8005 NW Norwick Ave
Lawton, OK 73505-4033
Phone (580) 713-9810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241127000860 OK Practitioner - Certified Clinical Nurse Specialist (CNS) 3476088402 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cancer Centers of Southwest Oklahoma, LLCGroup PAC ID 7810065323, 20 clinicians

Practice addresses (Care Compare)

104 NW 31St St
Lawton, OK 73505-6100
Phone (580) 536-2121

Hospital & facility affiliations

  • Memorial Health Hospital, Lawton, OK, CCN 370056
  • Duncan Regional Hospital, Inc Hospital, Duncan, OK, CCN 370023
  • Grady Memorial Hospital Hospital, Chickasha, OK, CCN 370054

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Science

State licenses

LicenseStateTypeSpecialty
219833OKMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cancer Centers of Southwest Oklahoma, LLC CurrentSince Oct 15, 2024 Accepting new patients
Cancer Centers of Southwest Oklahoma, LLC Current Accepting new patients
Cancer Centers of Southwest Oklahoma, LLC CurrentSince Oct 15, 2024 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

2222 W Iowa Ave
Chickasha, OK 73018

104 NW 31st St
Lawton, OK 73505
Phone (580) 536-2121

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1144088048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8005 NW NORWICK AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735054033",
            "telephone_number": "580-713-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 NW 31ST ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056100",
            "telephone_number": "805-362-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MCKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-06",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OK",
            "license": "219833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.