Magnolia Med Spa and IV Therapy Inc.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

MAGNOLIA MED SPA AND IV THERAPY INC.

Practice address

3008 W University Blvd Ste 130
Durant, OK 74701-2927

Phone

(580) 615-0000

Fax

(580) 615-0001

NPI assigned

Jul 16, 2024

Organization subpart

No

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

Authorized official

Name

Brittany Lee Ballard, BSN

Title

Owner

Phone

(580) 615-0000

Specialties & licenses 1

Addresses

Other names 1

• MAGNOLIA MED SPA AND IV THERAPY Doing business as

Locations

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1699513598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 W UNIVERSITY BLVD STE 130",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012927",
            "telephone_number": "580-615-0000",
            "fax_number": "580-615-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3008 W UNIVERSITY BLVD STE 130",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012927",
            "telephone_number": "580-615-0000",
            "fax_number": "580-615-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MED SPA AND IV THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-615-0000",
        "authorized_official_credential": "BSN"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAGNOLIA MED SPA AND IV THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Lujan
• Charlene Alexandra Lyons, MS CCC-SLP
• Sarah Mack, DO
• Michael Trent Macon, PHARMD
• Makenzie Ray Magby
• Magnolia Smiles
• Marquin Lynn Malone
• Hailey Cheyenne Manners
• Jo Lyn Manry
• Heather Marcum, APRN

• Medical Specialty Clinic/Center in Durant, OK
• Providers in Durant, OK by specialty
• Medical Specialty Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.