Doctor Name: | MRS. JAZMINE RENA O'KELLEY |
NPI Number: | 1063877736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S. |
License Number: | 238194 |
Business Practice Address: | 1405 E Moses Cushing, OK - 74023 |
Business Phone Number: | 9182255600 |
Business Fax Number: | |
Mailing Address: | 1405 E Moses, CUSHING |
State: | OK |
Postal Code: | 74023 |
Phone Number: | 9182255600 |
Fax Number: | 9182253026 |
NPI Enumeration Date: | 12/23/2015 |
NPI Last Update Date: | 12/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 238194 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |