Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 424376 | OK |
NPI | 1003580622 |
---|---|
Provider Name | Jose Hernandez |
First Address | Edmond, OK 73034-6159 |
Second Address | Edmond, OK 73034-6159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2021 |
Last Update Date | 06/08/2021 |